Healthcare Provider Details

I. General information

NPI: 1255463600
Provider Name (Legal Business Name): JOHN CASTRONOVO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 CROPSEY AVE
BROOKLYN NY
11214
US

IV. Provider business mailing address

83 PANCOAST ROAD
WARETOWN NJ
08758
US

V. Phone/Fax

Practice location:
  • Phone: 718-946-5802
  • Fax:
Mailing address:
  • Phone: 609-971-8151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number129083
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: