Provider Demographics
NPI:1437208592
Name:NJ NICASTRO DENTAL PC
Entity Type:Organization
Organization Name:NJ NICASTRO DENTAL PC
Other - Org Name:NJ NICASTRO ASSOCIATES LLP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:NICASTRO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-928-2020
Mailing Address - Street 1:5225 NESCONSET HWY
Mailing Address - Street 2:SUITE 52
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-2053
Mailing Address - Country:US
Mailing Address - Phone:631-928-2020
Mailing Address - Fax:631-928-2417
Practice Address - Street 1:5225 NESCONSET HWY
Practice Address - Street 2:SUITE 52
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2053
Practice Address - Country:US
Practice Address - Phone:631-928-2020
Practice Address - Fax:631-928-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty