Provider Demographics
NPI:1962504753
Name:OSTERGAARD, PAUL A (MDPC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:OSTERGAARD
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 TURNPIKE TPKE
Mailing Address - Street 2:
Mailing Address - City:POMPTON PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07444-1327
Mailing Address - Country:US
Mailing Address - Phone:973-839-8666
Mailing Address - Fax:973-839-3132
Practice Address - Street 1:679 TURNPIKE
Practice Address - Street 2:
Practice Address - City:POMPTON PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07444
Practice Address - Country:US
Practice Address - Phone:973-839-8666
Practice Address - Fax:973-839-3132
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02316400207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ018672Medicare PIN
C53547Medicare UPIN