Provider Demographics
NPI:1669525598
Name:PISTILLI, GUY DAVID (DC)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:DAVID
Last Name:PISTILLI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2713
Mailing Address - Country:US
Mailing Address - Phone:856-848-1515
Mailing Address - Fax:856-845-7753
Practice Address - Street 1:223 S EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2713
Practice Address - Country:US
Practice Address - Phone:856-848-1515
Practice Address - Fax:856-845-7753
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00365600111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ538844T8DMedicare ID - Type Unspecified
NJU25013Medicare UPIN