Provider Demographics
NPI:1821071754
Name:PRYSTOWSKY, LIGAYA (MD)
Entity Type:Individual
Prefix:
First Name:LIGAYA
Middle Name:
Last Name:PRYSTOWSKY
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 1:665 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1209
Mailing Address - Country:US
Mailing Address - Phone:973-667-4008
Mailing Address - Fax:973-667-1655
Practice Address - Street 1:665 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1209
Practice Address - Country:US
Practice Address - Phone:973-667-4008
Practice Address - Fax:973-667-1655
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04185000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1582003Medicaid
NJ452776TQ0Medicare PIN
NJ1582003Medicaid