Healthcare Provider Details

I. General information

NPI: 1376549154
Provider Name (Legal Business Name): ROBERT JOHN CASTELLI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT JOHN CASTELLI DPM PC

II. Dates (important events)

Enumeration Date: 06/25/2005
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8612 JAMAICA AVE
WOODHAVEN NY
11421-2042
US

IV. Provider business mailing address

8612 JAMAICA AVE
WOODHAVEN NY
11421-2042
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-7872
  • Fax: 718-846-6001
Mailing address:
  • Phone: 718-846-7872
  • Fax: 718-846-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberNY004630
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number004630
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: