Provider Demographics
NPI:1811148307
Name:CASTLE HEALTH CARE
Entity type:Organization
Organization Name:CASTLE HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CASELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:973-877-5522
Mailing Address - Street 1:111 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1909
Mailing Address - Country:US
Mailing Address - Phone:973-624-4908
Mailing Address - Fax:973-877-5595
Practice Address - Street 1:111 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1909
Practice Address - Country:US
Practice Address - Phone:973-624-4908
Practice Address - Fax:973-877-5595
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KIDNEY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB053986207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6210201Medicaid
NJ6210201Medicaid