Healthcare Provider Details

I. General information

NPI: 1053051599
Provider Name (Legal Business Name): ERICA BRAUN CASELLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BETHANY RD STE 65
HAZLET NJ
07730-1667
US

IV. Provider business mailing address

163 14TH ST APT 8
HOBOKEN NJ
07030-4482
US

V. Phone/Fax

Practice location:
  • Phone: 732-264-0700
  • Fax: 732-264-1414
Mailing address:
  • Phone: 201-983-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number25MA12738200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA12738200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: