1306888912 NPI number — FRANK JOSEPH CASELLA D.O.

Table of content: FRANK JOSEPH CASELLA D.O. (NPI 1306888912)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306888912 NPI number — FRANK JOSEPH CASELLA D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASELLA
Provider First Name:
FRANK
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASELLA
Provider Other First Name:
FRANK
Provider Other Middle Name:
JOSEPH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
I
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306888912
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
532 LAFAYETTE RD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SPARTA
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07871-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-940-0423
Provider Business Mailing Address Fax Number:
973-729-3454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
89 SPARTA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07871-1777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-729-2121
Provider Business Practice Location Address Fax Number:
973-729-3454
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  MB053986 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 25MB05398600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6210201 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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