Provider Demographics
NPI:1265625909
Name:CASTALDI, JENNIFER MARIE (APRN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:CASTALDI
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:90 S. BEDFORD ROAD
Mailing Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-1516
Practice Address - Street 1:90 SOUTH BEDFORD ROAD
Practice Address - Street 2:MOUNT KISCO MEDICAL GROUP PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-1412
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT003662363L00000X
NYF335764363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03093574Medicaid
NY03093574Medicaid