MEDICARE: ENRIQUE RUDIBER CASTELLANOS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	26NR22716500	NJ
2	363LF0000X	Family Nurse Practitioner	26NJ15522300	NJ

General Provider Information

NPI Number	:	1427563824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENRIQUE RUDIBER CASTELLANOS NP

Provider Business Mailing Address
First Line	:	99 GORGE RD APT 1511
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1097
Country	:	US
Telephone Number	:	718-514-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 GORGE RD APT 1511
Second Line	:
City	:	EDGEWATER
State	:	NJ
Zip	:	07020-1097
Country	:	US
Telephone Number	:	718-514-3690
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2017
Last Update Date	:	02/25/2026

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