Healthcare Provider Details

I. General information

NPI: 1336129931
Provider Name (Legal Business Name): CHRISTIE J PRESTIFILIPPO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

IV. Provider business mailing address

19 E MAIN ST
MENDHAM NJ
07945-1503
US

V. Phone/Fax

Practice location:
  • Phone: 973-543-6505
  • Fax: 973-543-2967
Mailing address:
  • Phone: 973-543-6505
  • Fax: 973-543-2967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA71130
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: