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General NPI Number Information
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NPI Number | 1366721573
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Entity Type | Individual
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Provider Name | JOHN P CASTRONOVA D.M.D
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Gender | Male
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Dates
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Enumeration Date | 08/05/2011
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 79 AVE U
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City | BROOKLYN
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State | NJ
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Zip | 07012
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Country | US
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Telephone | 718-373-6707
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Fax |
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Provider Business Mailing Address
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Address Line | 19 CHARLES ST
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City | NUTLEY
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State | NJ
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Zip | 07110-1032
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Country | US
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Telephone | 973-420-0886
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 057351
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 22DI02562700
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License Number State | NJ
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