Healthcare Provider Details

I. General information

NPI: 1972831469
Provider Name (Legal Business Name): LON A. CASTLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2009
Last Update Date: 11/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PARSONS POND DR MAILSTOP F2-2
FRANKLIN LAKES NJ
07417-2604
US

IV. Provider business mailing address

100 PARSONS POND DR MAILSTOP F2-2
FRANKLIN LAKES NJ
07417-2604
US

V. Phone/Fax

Practice location:
  • Phone: 201-269-6293
  • Fax: 201-269-1031
Mailing address:
  • Phone: 201-269-6293
  • Fax: 201-269-1031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberJ7444
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35.066505
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number130781
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: