Healthcare Provider Details

I. General information

NPI: 1336524529
Provider Name (Legal Business Name): ROBERT L SISTLER JR. LSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1076 ROUTE 47 S
RIO GRANDE NJ
08242-1608
US

IV. Provider business mailing address

40 STAGECOACH RD
MARMORA NJ
08223-1438
US

V. Phone/Fax

Practice location:
  • Phone: 609-741-6363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL06081800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: