Healthcare Provider Details

I. General information

NPI: 1568222081
Provider Name (Legal Business Name): ANTHONY CASTRONOVA DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2024
Last Update Date: 03/21/2024
Certification Date: 03/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 CHARLES ST
NUTLEY NJ
07110-1032
US

IV. Provider business mailing address

19 CHARLES ST
NUTLEY NJ
07110-1032
US

V. Phone/Fax

Practice location:
  • Phone: 973-493-1194
  • Fax:
Mailing address:
  • Phone: 973-493-1194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberC07810536507972
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: