Healthcare Provider Details

I. General information

NPI: 1114101086
Provider Name (Legal Business Name): SIMONE CASTOR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 MAIN ST 2ND FLOOR
WEST ORANGE NJ
07052-5460
US

IV. Provider business mailing address

66 W GILBERT ST 2ND FLOOR
TINTON FALLS NJ
07701-4947
US

V. Phone/Fax

Practice location:
  • Phone: 973-324-2111
  • Fax: 397-324-5880
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA00731000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: