Healthcare Provider Details

I. General information

NPI: 1598782567
Provider Name (Legal Business Name): CARLO DE CASTRO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 RAHWAY AVE
WOODBRIDGE NJ
07095-3648
US

IV. Provider business mailing address

118 STRONG PL
SOUTH PLAINFIELD NJ
07080-2620
US

V. Phone/Fax

Practice location:
  • Phone: 201-533-0055
  • Fax: 201-533-0066
Mailing address:
  • Phone: 908-344-2084
  • Fax: 201-533-0066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01118800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: