Provider Demographics
NPI:1700069259
Name:CASELLA, JOSEPH PETER (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PETER
Last Name:CASELLA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1763 2ND AVE APT 5H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5365
Mailing Address - Country:US
Mailing Address - Phone:646-246-0190
Mailing Address - Fax:
Practice Address - Street 1:2 E 76TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-2611
Practice Address - Country:US
Practice Address - Phone:212-628-4491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009606-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor