Provider Demographics
NPI:1841257201
Name:CASATELLI, BRUNO J (DPM)
Entity type:Individual
Prefix:DR
First Name:BRUNO
Middle Name:J
Last Name:CASATELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NEWTON SPARTA RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-2773
Mailing Address - Country:US
Mailing Address - Phone:973-383-0150
Mailing Address - Fax:973-300-1601
Practice Address - Street 1:39 NEWTON SPARTA RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-2773
Practice Address - Country:US
Practice Address - Phone:973-383-0150
Practice Address - Fax:973-300-1601
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00126500213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T44899Medicare UPIN
415098Medicare ID - Type Unspecified