Provider Demographics
NPI:1801976048
Name:PRYSTOWSKY, BARRY STUART (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:STUART
Last Name:PRYSTOWSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 KINGSLAND ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-3155
Mailing Address - Country:US
Mailing Address - Phone:973-235-0101
Mailing Address - Fax:973-667-5716
Practice Address - Street 1:562 KINGSLAND ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-3155
Practice Address - Country:US
Practice Address - Phone:973-235-0101
Practice Address - Fax:973-667-5716
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJMA042255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2704609Medicaid
C55778Medicare UPIN