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General NPI Number Information
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NPI Number | 1992483929
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Entity Type | Individual
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Provider Name | NICOLE CASTELLUCCIO PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 113 W ESSEX ST
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City | MAYWOOD
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State | NJ
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Zip | 07607-1023
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Country | US
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Telephone | 201-487-3400
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Fax | 201-603-1993
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Provider Business Mailing Address
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Address Line | 123 METRO BLVD
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City | NUTLEY
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State | NJ
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Zip | 07110-6101
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Country | US
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Telephone | 973-761-9000
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Fax | 201-603-1993
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00791700
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License Number State | NJ
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