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General NPI Number Information
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NPI Number | 1427563824
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Entity Type | Individual
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Provider Name | ENRIQUE RUDIBER CASTELLANOS NP
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Gender | Male
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 08/18/2026
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Provider Practice Location Address
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Address Line | 99 GORGE RD APT 1511
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City | EDGEWATER
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State | NJ
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Zip | 07020-1097
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Country | US
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Telephone | 718-514-3690
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Fax |
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Provider Business Mailing Address
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Address Line | 99 GORGE RD APT 1511
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City | EDGEWATER
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State | NJ
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Zip | 07020-1097
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Country | US
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Telephone | 718-514-3690
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 800208
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 26NJ15522300
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR22716500
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License Number State | NJ
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 359209
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License Number State | NY
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