Healthcare Provider Details

I. General information

NPI: 1518142603
Provider Name (Legal Business Name): DAVID CINCO CASTILLO D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MADISON AVENUE EMERGENCY MEDICINE RESIDENCY
MORRISTOWN NJ
07960
US

IV. Provider business mailing address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-7926
  • Fax: 973-290-7202
Mailing address:
  • Phone: 973-740-0607
  • Fax: 973-740-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08749200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: