Provider Demographics
NPI:1962651869
Name:DR. GREGORY A. PISTONE MDPC
Entity Type:Organization
Organization Name:DR. GREGORY A. PISTONE MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PISTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-988-8080
Mailing Address - Street 1:514 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4803
Mailing Address - Country:US
Mailing Address - Phone:856-988-8080
Mailing Address - Fax:856-596-3179
Practice Address - Street 1:514 LIPPINCOTT DR
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4803
Practice Address - Country:US
Practice Address - Phone:856-988-8080
Practice Address - Fax:856-596-3179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA037807174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ690988Medicare UPIN
PAB40862Medicare PIN