Provider Demographics
NPI:1871575613
Name:PUSTERLA, THOMAS EDWARD (DPM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:PUSTERLA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:245 MAIN ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07930-2569
Mailing Address - Country:US
Mailing Address - Phone:908-879-2818
Mailing Address - Fax:908-879-2418
Practice Address - Street 1:245 MAIN ST
Practice Address - Street 2:SUITE 112
Practice Address - City:CHESTER
Practice Address - State:NJ
Practice Address - Zip Code:07930-2569
Practice Address - Country:US
Practice Address - Phone:908-879-2818
Practice Address - Fax:908-879-2418
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MD00162900213EP1101X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT44941Medicare UPIN
NJ433569Medicare ID - Type Unspecified
NJ0755710002Medicare NSC