Provider Demographics
NPI:1275712978
Name:GISELE CASTELLUBER PA
Entity Type:Organization
Organization Name:GISELE CASTELLUBER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CASTELLUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-933-2333
Mailing Address - Street 1:477 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2625
Mailing Address - Country:US
Mailing Address - Phone:201-933-2333
Mailing Address - Fax:201-933-3885
Practice Address - Street 1:477 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2625
Practice Address - Country:US
Practice Address - Phone:201-933-2333
Practice Address - Fax:201-933-3885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68373261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8070806Medicaid
NJ8070806Medicaid