Individual
KYLE NICASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
235 HARTFORD RD, MEDFORD, NJ 08055-4000
(609) 820-4318
Mailing address
13 EDDLEWOOD PL, MOUNT LAUREL, NJ 08054-2639
(856) 816-5285
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00194800
NJ
2255A2300X
Athletic Trainer
RT005297
PA
Other
Enumeration date
04/19/2019
Last updated
04/19/2019
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