Provider Demographics
NPI:1942371711
Name:DR. ROBERT J. CASTELLI DPM PC
Entity Type:Organization
Organization Name:DR. ROBERT J. CASTELLI DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CASTELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-846-7872
Mailing Address - Street 1:8612 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2042
Mailing Address - Country:US
Mailing Address - Phone:718-846-7872
Mailing Address - Fax:718-846-6001
Practice Address - Street 1:8612 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2042
Practice Address - Country:US
Practice Address - Phone:718-846-7872
Practice Address - Fax:718-846-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004630213ES0131X
332B00000X
NY004630335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01157253Medicaid
NYT92850Medicare UPIN
NY0642470001Medicare NSC
NY63283Medicare PIN