Provider Demographics
NPI:1750859047
Name:CASTRO, NORIEL (PT)
Entity Type:Individual
Prefix:
First Name:NORIEL
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 KINGSLEY ST
Mailing Address - Street 2:
Mailing Address - City:LEONIA
Mailing Address - State:NJ
Mailing Address - Zip Code:07605-1615
Mailing Address - Country:US
Mailing Address - Phone:201-835-3256
Mailing Address - Fax:
Practice Address - Street 1:299 MARKET ST
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-5316
Practice Address - Country:US
Practice Address - Phone:201-355-4910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00572500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist