Individual
DR. JOSE R. BUSTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
201 LYONS AVE, NEWARK, NJ 07112-2027
(973) 926-7000
Mailing address
2414 EDWARD STEC BLVD, EDISON, NJ 08837-7008
(908) 451-2200
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MB09447600
NJ
208000000X
Pediatrics Physician
25MB09447600
NJ
Other
Enumeration date
08/22/2014
Last updated
08/22/2014
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