Provider Demographics
NPI:1710038740
Name:PASCACK HOSPITAL PHYSICIANS SERVICES, P.A.
Entity Type:Organization
Organization Name:PASCACK HOSPITAL PHYSICIANS SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:LA STELLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-358-3000
Mailing Address - Street 1:66 W GILBERT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-4947
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:250 OLD HOOK RD
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07675-3123
Practice Address - Country:US
Practice Address - Phone:201-358-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJCN2025OtherRAILROAD MEDICARE
NJ0955550OtherAMERIGROUP
NJ1153677OtherHORIZON NJ HEALTH
NJG620668OtherOXFORD
NJ381590OtherAMERIHEALTH
NJ7260407Medicaid
NJ1153677OtherHORIZON NJ HEALTH