Provider Demographics
NPI:1699840264
Name:CASTANEDA, JOSE (FNP)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07104-4309
Mailing Address - Country:US
Mailing Address - Phone:973-483-1300
Mailing Address - Fax:973-483-3787
Practice Address - Street 1:741 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07104-4309
Practice Address - Country:US
Practice Address - Phone:973-483-1300
Practice Address - Fax:973-483-3787
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26 NJ000625363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1932370483Other101 LUDLOW STREET
NJ1972778413Other1150 SPRINGFIELD AVE
NJ1548431091Other982 BROAD STREET
NJ1194996645Other444 WILLIAM STREET
NJ1235300799Other37 N DAY
NJ26NO011929300OtherSTATE LICENSE
NJ1740345693Other741 BROADWAY
NJ1740345693Other741 BROADWAY