Provider Demographics
NPI:1780672832
Name:PATESTOS, CHRIS A (MD)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:A
Last Name:PATESTOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 HOOPER AVE BLDG A2ND
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2586
Mailing Address - Country:US
Mailing Address - Phone:732-255-7553
Mailing Address - Fax:732-255-8901
Practice Address - Street 1:1314 HOOPER AVE BLDG 12ND
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2586
Practice Address - Country:US
Practice Address - Phone:732-255-7553
Practice Address - Fax:732-255-8901
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89901173000000X
NJ25MA06847400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269407700Medicaid