Healthcare Provider Details

I. General information

NPI: 1588022297
Provider Name (Legal Business Name): JYOTI SRIVASTAVA DDS & ROBERT CASTRACANE DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 MADISON AVE FL 27
NEW YORK NY
10022-1649
US

IV. Provider business mailing address

595 MADISON AVE FL 27
NEW YORK NY
10022-1649
US

V. Phone/Fax

Practice location:
  • Phone: 212-758-9498
  • Fax:
Mailing address:
  • Phone: 212-758-9498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. JYOTI SRIVASTAVA
Title or Position: CEO
Credential: MS,DDS
Phone: 212-758-9498