Provider Demographics
NPI:1992905814
Name:RESTIVO, JOSEPH STANLEY (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:STANLEY
Last Name:RESTIVO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 745390
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5390
Mailing Address - Country:US
Mailing Address - Phone:940-384-3810
Mailing Address - Fax:940-565-9588
Practice Address - Street 1:3535 S I 35 E
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6850
Practice Address - Country:US
Practice Address - Phone:940-384-3810
Practice Address - Fax:940-565-9588
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU0266207ZP0102X
KS05-35295207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology