Provider Demographics
NPI:1205165321
Name:BASTIANELLI, JAMES M (PT)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:M
Last Name:BASTIANELLI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 DUBLIN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-7708
Mailing Address - Country:US
Mailing Address - Phone:302-295-5317
Mailing Address - Fax:302-834-2365
Practice Address - Street 1:28 DUBLIN DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-7708
Practice Address - Country:US
Practice Address - Phone:302-295-5317
Practice Address - Fax:302-834-2365
Is Sole Proprietor?:No
Enumeration Date:2009-12-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000206174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist