Provider Demographics
NPI:1093761546
Name:PASTERNAK, PHILIP L (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:PASTERNAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-0067
Mailing Address - Country:US
Mailing Address - Phone:732-254-4000
Mailing Address - Fax:732-901-4337
Practice Address - Street 1:911 E COUNTY LINE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2069
Practice Address - Country:US
Practice Address - Phone:732-254-4000
Practice Address - Fax:732-901-4337
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07657600207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H70986Medicare UPIN
NJ096022Medicare PIN