Healthcare Provider Details

I. General information

NPI: 1639146954
Provider Name (Legal Business Name): ELSA I CASTRO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2006
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1623 ROUTE 88 W
BRICK NJ
08724-3048
US

IV. Provider business mailing address

PO BOX 1719 1623 ROUTE 88 WEST SUITE A
BRICK NJ
08723-1064
US

V. Phone/Fax

Practice location:
  • Phone: 732-458-9666
  • Fax: 908-325-1832
Mailing address:
  • Phone: 732-458-9666
  • Fax: 732-458-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA06951100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number25MA06951100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: