Provider Demographics
NPI:1528782638
Name:PASTIRKO, ALEXIS JORDYN
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:JORDYN
Last Name:PASTIRKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 CENTERTON RD
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3509
Mailing Address - Country:US
Mailing Address - Phone:856-297-0906
Mailing Address - Fax:
Practice Address - Street 1:201 MULLICA HILL RD
Practice Address - Street 2:
Practice Address - City:GLASSBORO
Practice Address - State:NJ
Practice Address - Zip Code:08028-1700
Practice Address - Country:US
Practice Address - Phone:856-545-8461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer