=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750559670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. AGOSTINO SARTORI
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2008
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 75 MAYHILL ST
-----------------------------------------------------
City | SADDLE BROOK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07663-5301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-712-9151
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 SPICE DR
-----------------------------------------------------
City | TOWNSHIP OF WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07676-3815
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 28RI01188800
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------