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General NPI Number Information
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NPI Number | 1093761546
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Entity Type | Individual
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Provider Name | PHILIP L PASTERNAK MD
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 911 E COUNTY LINE RD SUITE 201
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2069
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Country | US
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Telephone | 732-254-4000
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Fax | 732-901-4337
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Provider Business Mailing Address
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Address Line | PO BOX 67
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-0067
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Country | US
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Telephone | 732-254-4000
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Fax | 732-901-4337
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | MA07657600
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License Number State | NJ
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