1396752606 NPI number — MR. JOHN ROBERT CASTELLANI LCSW

Table of content: MR. JOHN ROBERT CASTELLANI LCSW (NPI 1396752606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396752606 NPI number — MR. JOHN ROBERT CASTELLANI LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTELLANI
Provider First Name:
JOHN
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396752606
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
419 WALNUT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NIAGARA FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14301-1725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-285-1904
Provider Business Mailing Address Fax Number:
716-284-8262

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
419 WALNUT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NIAGARA FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14301-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-285-1904
Provider Business Practice Location Address Fax Number:
716-284-8262
Provider Enumeration Date:
08/01/2006

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: 1041C0700X , with the licence number:  071748 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000528407001 . This is a "TRADITIONAL SECURE BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01465154 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000528407001 . This is a "BCBS WNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528407001 . This is a "FAMILY HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528407001 . This is a "HMO 100" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528407001 . This is a "CHILD HEALTH PLUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528407001 . This is a "COMMUNITY BLUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000528407001 . This is a "CB ADVANTAGE" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com