Basic Information
| Provider Information | |||||||||
| NPI: | 1023119757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ESTELLA | ||||||||
| FirstName: | FAUSTINO | ||||||||
| MiddleName: | FALGUI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 5191 | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087545191 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322444700 | ||||||||
| FaxNumber: | 7322448482 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 W WATER ST | ||||||||
| Address2: | |||||||||
| City: | TOMS RIVER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 087536407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322444700 | ||||||||
| FaxNumber: | 7322448482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 06/01/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 25MA03581700 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0106063000 | 01 | PERSONAL CHOICE BCBS | OTHER | 3272401 | 05 | NJ | MEDICAID | 020003621 | 01 | RAILROAD MEDICARE | OTHER | 0106063001 | 01 | AMERIHEALTH | OTHER | 1035428 | 01 | HORIZON NJ HEALTH | OTHER | 403663 | 01 | UHC | OTHER | 457530 | 01 | KEYSTONE | OTHER | 90000661400 | 01 | AMERICHOICE | OTHER | F11880 | 01 | HEALTHNET | OTHER | P3165303 | 01 | OXFORD | OTHER |