Healthcare Provider Details

I. General information

NPI: 1316861206
Provider Name (Legal Business Name): CHRISTIAN CASTELLANOS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 RIDGEHURST RD
WEST ORANGE NJ
07052-5717
US

IV. Provider business mailing address

19 RIDGEHURST RD
WEST ORANGE NJ
07052-5717
US

V. Phone/Fax

Practice location:
  • Phone: 973-444-4938
  • Fax:
Mailing address:
  • Phone: 973-444-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15604600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: