Provider Demographics
NPI:1548396070
Name:PISTONE, JOSEPH J JR (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:PISTONE
Suffix:JR
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 S EGG HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1417
Mailing Address - Country:US
Mailing Address - Phone:609-567-2586
Mailing Address - Fax:609-567-7811
Practice Address - Street 1:421 S EGG HARBOR RD
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1417
Practice Address - Country:US
Practice Address - Phone:609-567-2586
Practice Address - Fax:609-567-7811
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD1016156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1106110001Medicare ID - Type Unspecified