Provider Demographics
NPI:1518163260
Name:BARTELL, PETER D (DO, HAD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:D
Last Name:BARTELL
Suffix:
Gender:M
Credentials:DO, HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-2150
Mailing Address - Country:US
Mailing Address - Phone:908-233-5512
Mailing Address - Fax:
Practice Address - Street 1:110 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2150
Practice Address - Country:US
Practice Address - Phone:908-233-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0003321156FX1800X
NJ00987237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0696100001Medicare NSC