Provider Demographics
NPI:1922182161
Name:GURSTELLE, EMILE BERTRAND (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILE
Middle Name:BERTRAND
Last Name:GURSTELLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 CAREY AVE
Mailing Address - Street 2:STE 204
Mailing Address - City:BUTLER
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-1475
Mailing Address - Country:US
Mailing Address - Phone:973-527-4411
Mailing Address - Fax:973-527-4409
Practice Address - Street 1:45 CAREY AVE
Practice Address - Street 2:STE 204
Practice Address - City:BUTLER
Practice Address - State:NJ
Practice Address - Zip Code:07405-1475
Practice Address - Country:US
Practice Address - Phone:973-527-4411
Practice Address - Fax:973-527-4409
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100160800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ703037C4QMedicare ID - Type Unspecified
NJR33727Medicare UPIN