Healthcare Provider Details

I. General information

NPI: 1558562967
Provider Name (Legal Business Name): FRED KASTENBAUM DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 PARK AVE APT 10C
NEW YORK NY
10021-4946
US

IV. Provider business mailing address

710 PARK AVE APT 10C
NEW YORK NY
10021-4946
US

V. Phone/Fax

Practice location:
  • Phone: 917-693-9455
  • Fax:
Mailing address:
  • Phone: 917-693-9455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number032935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: