Provider Demographics
NPI:1467428904
Name:CASWELL, PHILIP C (DPM)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:C
Last Name:CASWELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3204
Mailing Address - Country:US
Mailing Address - Phone:973-300-9151
Mailing Address - Fax:973-300-9175
Practice Address - Street 1:122 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3204
Practice Address - Country:US
Practice Address - Phone:973-300-9151
Practice Address - Fax:973-300-9175
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD002494213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4220770001Medicare NSC
NJ047935Medicare PIN