Basic Information
| Provider Information | |||||||||
| NPI: | 1699840264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTANEDA | ||||||||
| FirstName: | JOSE | ||||||||
| MiddleName: | |||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
| FaxNumber: | 9734833787 | ||||||||
| Practice Location | |||||||||
| Address1: | 741 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071044309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734831300 | ||||||||
| FaxNumber: | 9734833787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 03/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 26 NJ000625 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1932370483 | 01 | NJ | 101 LUDLOW STREET | OTHER | 1972778413 | 01 | NJ | 1150 SPRINGFIELD AVE | OTHER | 1548431091 | 01 | NJ | 982 BROAD STREET | OTHER | 1194996645 | 01 | NJ | 444 WILLIAM STREET | OTHER | 1235300799 | 01 | NJ | 37 N DAY | OTHER | 26NO011929300 | 01 | NJ | STATE LICENSE | OTHER | 1740345693 | 01 | NJ | 741 BROADWAY | OTHER |