Provider Demographics
NPI:1699774620
Name:PASTERNACK, WARREN A (DPM)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:A
Last Name:PASTERNACK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JASON DR
Mailing Address - Street 2:
Mailing Address - City:E BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-3342
Mailing Address - Country:US
Mailing Address - Phone:732-254-1007
Mailing Address - Fax:
Practice Address - Street 1:B2 BRIER HILL CT
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-3348
Practice Address - Country:US
Practice Address - Phone:732-254-9302
Practice Address - Fax:732-613-4758
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00116600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0650404Medicaid
NJT45030Medicare UPIN
NJ0650404Medicaid