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General NPI Number Information
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NPI Number | 1871575613
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Entity Type | Individual
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Provider Name | THOMAS EDWARD PUSTERLA DPM
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 245 MAIN ST SUITE 112
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City | CHESTER
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State | NJ
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Zip | 07930-2569
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Country | US
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Telephone | 908-879-2818
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Fax | 908-879-2418
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Provider Business Mailing Address
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Address Line | 245 MAIN ST SUITE 112
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City | CHESTER
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State | NJ
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Zip | 07930-2569
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Country | US
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Telephone | 908-879-2818
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Fax | 908-879-2418
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | 25MD00162900
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 25MD00162900
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License Number State | NJ
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