Provider Demographics
NPI:1710077979
Name:CASTELLINI, LESLEY (LAC, DC)
Entity Type:Individual
Prefix:MS
First Name:LESLEY
Middle Name:
Last Name:CASTELLINI
Suffix:
Gender:F
Credentials:LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2002
Mailing Address - Country:US
Mailing Address - Phone:732-219-1900
Mailing Address - Fax:732-219-0202
Practice Address - Street 1:206 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2002
Practice Address - Country:US
Practice Address - Phone:732-219-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00193600111N00000X
NJ25MZ00019400171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223192637OtherTAX ID
NJP2792566OtherOXFORD ID
NJP2792566OtherOXFORD ID
NJU39533Medicare UPIN