Nicole Castelluccio, PA-C – Physician Assistant

Key facts

NPI: 1992483929
Entity type: Individual (NPI type 1)
Primary specialty: Physician Assistant 363A00000X
License: 25MP00791700 (NJ)
Practice address: 113 W Essex St
Maywood, NJ 07607-1023
Phone: (201) 487-3400
Fax: (201) 603-1993
NPI assigned: Jul 10, 2023
Sex: Female
Sole proprietor: Yes

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Aesthetic & Reconstructive Surgeons, LLC Plastic Surgery Physician · Rochelle Park, NJ · NPI 1396914420

Medicare reassignment Care Compare group NJ

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

HMH Hospitals Corporation General Acute Care Hospital · Hackensack, NJ · NPI 1457456279

Care Compare affiliation Hospital
HMH Hospitals Corporation Clinical Medical Laboratory · Hackensack, NJ · NPI 1518683929

Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty: Physician Assistant
Education: Other, 2023
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Aesthetic and Reconstructive Surgeons, LLC (6 clinicians)

Practice addresses (Care Compare)

113 W Essex St
Suite 202
Maywood, NJ 07607-1023

30 Prospect Ave
Hackensack, NJ 07601-1915
Phone (201) 996-2000

Hospital & facility affiliations

Hackensack University Medical Center Hospital · Hackensack, NJ · CCN 310001

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NJ
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20231213000908	NJ	Practitioner - Physician Assistant	9032568282	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Physician Assistant

State licenses

License	State	Type	Specialty
25MP00791700	NJ	MD	Physician Assistant

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physician Assistant	363A00000X	25MP00791700	NJ	Yes

Addresses

Primary practice location

113 W Essex St
Maywood, NJ 07607-1023

Mailing address

123 Metro Blvd
Nutley, NJ 07110-6101
Phone (973) 761-9000

Other providers in Maywood, NJ

Matthew David Cannon, MAED, MAT, BCBA
Liza Dorado Capistrano, RN
Caressing Care, LLC
Jeanette Carlo
Eileen Ann Ortiga Carmona
Karen Ann Castka, MS, CCC-SLP
Centromere Diagnostic, LLC
Mariam R Chandler, APN
Children'S Aid and Family Services, Inc.
Thomas R. Christiano, MD

All providers in Maywood, NJ · Physician Assistant in New Jersey

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2024. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.