Provider Demographics
NPI:1013038108
Name:FAUSTINO F. ESTELLA, M.D., P.A.
Entity Type:Organization
Organization Name:FAUSTINO F. ESTELLA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAUSTINO
Authorized Official - Middle Name:F
Authorized Official - Last Name:ESTELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-339-9010
Mailing Address - Street 1:330 ROUTE 45
Mailing Address - Street 2:WOODSTOWN RD., SUITE 2
Mailing Address - City:SALEM
Mailing Address - State:NJ
Mailing Address - Zip Code:08079-2034
Mailing Address - Country:US
Mailing Address - Phone:856-339-9010
Mailing Address - Fax:
Practice Address - Street 1:330 ROUTE 45
Practice Address - Street 2:WOODSTOWN RD., SUITE 2
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079-2034
Practice Address - Country:US
Practice Address - Phone:856-339-9010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03581700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0031889OtherAETNA
NJ403663OtherUNITED HEALTHCARE
NJ0106063000OtherAMERIHEALTH
NJ3272401Medicaid
NJ3272401Medicaid
NJ0106063000OtherAMERIHEALTH