MEDICARE: MR. ROBERT L SISTLER JR. LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06081800	NJ

General Provider Information

NPI Number	:	1336524529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT L SISTLER JR. LSW

Provider Business Mailing Address
First Line	:	40 STAGECOACH RD
Second Line	:
City	:	MARMORA
State	:	NJ
Zip	:	08223-1438
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1076 ROUTE 47 S
Second Line	:
City	:	RIO GRANDE
State	:	NJ
Zip	:	08242-1608
Country	:	US
Telephone Number	:	609-741-6363
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2015
Last Update Date	:	07/29/2015

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