Healthcare Provider Details

I. General information

NPI: 1952584393
Provider Name (Legal Business Name): DR LESLEY CASTELLINI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 BROAD ST
RED BANK NJ
07701-2002
US

IV. Provider business mailing address

206 BROAD ST
RED BANK NJ
07701-2002
US

V. Phone/Fax

Practice location:
  • Phone: 732-219-1900
  • Fax: 732-219-0202
Mailing address:
  • Phone: 732-219-1900
  • Fax: 732-219-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00193600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00019400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. LESLEY J CASTELLINI
Title or Position: SOLE PROPRIETOR
Credential: LAC DC
Phone: 732-219-1900