Provider Demographics
NPI:1366721573
Name:CASTRONOVA, JOHN P (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:P
Last Name:CASTRONOVA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1032
Mailing Address - Country:US
Mailing Address - Phone:973-420-0886
Mailing Address - Fax:
Practice Address - Street 1:79 AVE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NJ
Practice Address - Zip Code:07012
Practice Address - Country:US
Practice Address - Phone:718-373-6707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2022-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0573511223X0400X
NJ22DI025627001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04108210Medicaid
NJ0442453Medicaid