Provider Demographics
NPI:1568423960
Name:POLICASTRO, BRIAN C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:POLICASTRO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1945 RTE 33
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4859
Mailing Address - Country:US
Mailing Address - Phone:732-776-4949
Mailing Address - Fax:732-776-4843
Practice Address - Street 1:1945 RTE 33
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4859
Practice Address - Country:US
Practice Address - Phone:732-776-4949
Practice Address - Fax:732-776-4843
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00123100363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO1162444OtherRAILROAD MEDICARE
NJ255727YJ50Medicare PIN
NJ089431Medicare ID - Type Unspecified