Healthcare Provider Details

I. General information

NPI: 1891003273
Provider Name (Legal Business Name): MR. SHERWIN A CASTRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2010
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 CLIFTON AVE
CLIFTON NJ
07013-3619
US

IV. Provider business mailing address

20 DONALD ST APT. C
BLOOMFIELD NJ
07003-6124
US

V. Phone/Fax

Practice location:
  • Phone: 973-246-6565
  • Fax: 973-883-0140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01304200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number029041
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: