Provider Demographics
NPI:1063436780
Name:KASTUK, PAUL J JR (DC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:KASTUK
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 PEEKSKILL HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:PUTNAM VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10579-3248
Mailing Address - Country:US
Mailing Address - Phone:845-528-2828
Mailing Address - Fax:845-528-5135
Practice Address - Street 1:21 PEEKSKILL HOLLOW RD
Practice Address - Street 2:
Practice Address - City:PUTNAM VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10579-3248
Practice Address - Country:US
Practice Address - Phone:845-528-2828
Practice Address - Fax:845-528-5135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX27891Medicare ID - Type UnspecifiedMEDICARE PROVIDER #