Active NPI
Barry Stuart Prystowsky, MD
- Pediatrics Physician
- Nutley, NJ
National Provider Identifier
1801976048
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- NJMA042255
- Practice address
- 562 Kingsland St
Nutley, NJ 07110-3155 - Phone
- (973) 235-0101
- Fax
- (973) 667-5716
- NPI assigned
- Oct 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | NJMA042255 | NJ | Primary |
Addresses
Primary practice location
562 Kingsland St
Nutley, NJ 07110-3155
Mailing address
562 Kingsland St
Nutley, NJ 07110-3155
Phone (973) 235-0101
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2704609 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NJMA042255 | NJ | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323734400000",
"number": "1801976048",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "562 KINGSLAND ST",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "071103155",
"telephone_number": "973-235-0101",
"fax_number": "973-667-5716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "562 KINGSLAND ST",
"city": "NUTLEY",
"state": "NJ",
"postal_code": "071103155",
"telephone_number": "973-235-0101",
"fax_number": "973-667-5716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRYSTOWSKY",
"first_name": "BARRY",
"middle_name": "STUART",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-16",
"last_updated": "2011-12-13",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "NJ",
"license": "NJMA042255",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2704609",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nutley, NJ
- Pro Staff Physical Therapy PC
- Professional Occupational & Physical Therapy, PLLC
- Professional Occupational & Physical Therapy, PLLC
- Professional Orthopedic and Sports Physical Therapy of NJ, LLC
- Professional Orthopedic and Sports Physical Therapy of NJ, LLC
- Ligaya Prystowsky, M.D.
- Lily Pugliese, CA
- Abigail Linda Pumm, PA-C
- Pure Synergy Physical Therapy, LLC
- Erin Puso
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.