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General NPI Number Information
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NPI Number | 1144962259
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Entity Type | Organization
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Legal Business Name | BERGENFIELD ORTHODONTICS
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 59 N WASHINGTON AVE
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City | BERGENFIELD
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State | NJ
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Zip | 07621-1751
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Country | US
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Telephone | 973-420-0886
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Fax |
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Provider Business Mailing Address
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Address Line | 33 GARFIELD PL
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3724
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JOHN CASTRONOVA
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Credential |
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Telephone | 973-420-0886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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