Provider Demographics
NPI:1154846996
Name:CASTILLO, JOSEPHINE (NP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PAULA DR
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3519
Mailing Address - Country:US
Mailing Address - Phone:201-387-6970
Mailing Address - Fax:
Practice Address - Street 1:354 DOREMUS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-4882
Practice Address - Country:US
Practice Address - Phone:973-274-7790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF307690363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health