Provider Demographics
NPI:1639146954
Name:CASTRO, ELSA I (MD)
Entity Type:Individual
Prefix:DR
First Name:ELSA
Middle Name:I
Last Name:CASTRO
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:PO BOX 1719
Mailing Address - Street 2:1623 ROUTE 88 WEST SUITE A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-1064
Mailing Address - Country:US
Mailing Address - Phone:732-458-9666
Mailing Address - Fax:732-458-0840
Practice Address - Street 1:1623 ROUTE 88 W
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-3048
Practice Address - Country:US
Practice Address - Phone:732-458-9666
Practice Address - Fax:732-458-0840
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06951100174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA06951100OtherLICENSE
NJ8331006Medicaid