Provider Demographics
NPI:1154454791
Name:DR ANTHONY M PASTENA LLC
Entity Type:Organization
Organization Name:DR ANTHONY M PASTENA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PASTENA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-542-0384
Mailing Address - Street 1:438 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:TOWNSHIP OF WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07676-5066
Mailing Address - Country:US
Mailing Address - Phone:973-542-0384
Mailing Address - Fax:973-542-1172
Practice Address - Street 1:249 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2710
Practice Address - Country:US
Practice Address - Phone:973-542-0384
Practice Address - Fax:973-542-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06310300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ112176Medicare PIN
NJG57955Medicare UPIN