Provider Demographics
NPI:1710035084
Name:PRESTI, PAUL MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MATTHEW
Last Name:PRESTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:MATTHEW
Other - Last Name:PRESTI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:213 SUMMIT RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2316
Mailing Address - Country:US
Mailing Address - Phone:908-233-2111
Mailing Address - Fax:908-458-9944
Practice Address - Street 1:213 SUMMIT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-233-2111
Practice Address - Fax:908-458-9944
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240704207Y00000X
NJ25MA08409300207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology