Provider Demographics
NPI:1043300577
Name:PETERS, NANCY CASTELLUCCI (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CASTELLUCCI
Last Name:PETERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 ROUTE 34
Mailing Address - Street 2:SUITE 813
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2439
Mailing Address - Country:US
Mailing Address - Phone:732-431-2620
Mailing Address - Fax:732-431-3707
Practice Address - Street 1:281 ROUTE 34
Practice Address - Street 2:SUITE 813
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2439
Practice Address - Country:US
Practice Address - Phone:732-431-2620
Practice Address - Fax:732-431-3707
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA66367207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0312142Medicaid
NJ045193ZEL1Medicare PIN
NJ0312142Medicaid