Provider Demographics
NPI:1598792566
Name:BASTIEN, PASCALE (MD)
Entity Type:Individual
Prefix:DR
First Name:PASCALE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8008 ROUTE 130 NORTH, SUITE 204
Mailing Address - Street 2:
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-1869
Mailing Address - Country:US
Mailing Address - Phone:856-824-0099
Mailing Address - Fax:856-824-0088
Practice Address - Street 1:8008 ROUTE 130 N, SUITE 204
Practice Address - Street 2:
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-1869
Practice Address - Country:US
Practice Address - Phone:856-824-0099
Practice Address - Fax:856-824-0088
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA649112080A0000X
NJ25MA06491100208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7109407Medicaid
NJ7109407Medicaid