Provider Demographics
NPI:1467601369
Name:BISTARELLI, FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:
Last Name:BISTARELLI
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 1:2 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:NJ
Mailing Address - Zip Code:07620
Mailing Address - Country:US
Mailing Address - Phone:201-768-0243
Mailing Address - Fax:201-768-3327
Practice Address - Street 1:2 CAMBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:NJ
Practice Address - Zip Code:07620
Practice Address - Country:US
Practice Address - Phone:201-768-0243
Practice Address - Fax:201-768-3327
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02691600207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology