Provider Demographics
NPI:1568500882
Name:CASTELLUBER, GISELE BVM (MD)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:BVM
Last Name:CASTELLUBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 STUYVESANT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2625
Mailing Address - Country:US
Mailing Address - Phone:201-933-2333
Mailing Address - Fax:201-933-3885
Practice Address - Street 1:477 STUYVESANT AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2625
Practice Address - Country:US
Practice Address - Phone:201-933-2333
Practice Address - Fax:201-933-3885
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA068373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8070806Medicaid
NJ8070806Medicaid
NJ024445Medicare ID - Type Unspecified