Provider Demographics
NPI:1376549154
Name:CASTELLI, ROBERT JOHN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:CASTELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:JOHN
Other - Last Name:CASTELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM PC
Mailing Address - Street 1:8612 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2042
Mailing Address - Country:US
Mailing Address - Phone:718-846-7872
Mailing Address - Fax:718-846-6001
Practice Address - Street 1:8612 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2042
Practice Address - Country:US
Practice Address - Phone:718-846-7872
Practice Address - Fax:718-846-6001
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-25
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY004630332B00000X
NY004630213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY004630OtherNY STATE LICENSE NUMBER
NY01157253Medicaid
NY04196609Medicaid
FLPO 002040OtherFLORIDA STATE LICENSE
NY63283Medicare PIN
NYT92850Medicare UPIN