Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 129083 | NY |
NPI | 1255463600 |
---|---|
Provider Name | Dr. John Castronovo |
First Address | Waretown, NJ 08758 |
Second Address | Brooklyn, NY 11214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B11011 | (02) |