Healthcare Provider Details

I. General information

NPI: 1669332979
Provider Name (Legal Business Name): ROBERT J. CASTELLI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2296
US

IV. Provider business mailing address

79 MIDDLEVILLE RD
NORTHPORT NY
11768-2296
US

V. Phone/Fax

Practice location:
  • Phone: 631-261-4400
  • Fax:
Mailing address:
  • Phone: 631-261-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: