Provider Demographics
NPI:1386685808
Name:CASTANEDA, GENEVIEVE S (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:GENEVIEVE
Middle Name:S
Last Name:CASTANEDA
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:170 CHANGEBRIDGE RD
Mailing Address - Street 2:BLDG C3
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9112
Mailing Address - Country:US
Mailing Address - Phone:973-535-8870
Mailing Address - Fax:973-535-8818
Practice Address - Street 1:22 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 201
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5604
Practice Address - Country:US
Practice Address - Phone:973-535-8870
Practice Address - Fax:973-535-8818
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2017-04-24
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00126000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJQ26915Medicare UPIN