1528322542 NPI number — DR. JORGE ERNESTO CASTILLO M.D.

Table of content: DR. JORGE ERNESTO CASTILLO M.D. (NPI 1528322542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528322542 NPI number — DR. JORGE ERNESTO CASTILLO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
JORGE
Provider Middle Name:
ERNESTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1528322542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 300
Provider Second Line Business Mailing Address:
CENTRAL NEW YORK PSYCHIATRIC CENTER
Provider Business Mailing Address City Name:
MARCY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-398-7071
Provider Business Mailing Address Fax Number:
845-398-7066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9005 OLD RIVER ROAD
Provider Second Line Business Practice Location Address:
CENTRAL NEW YORK PSYCHIATRIC CENTER
Provider Business Practice Location Address City Name:
MARCY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-398-7071
Provider Business Practice Location Address Fax Number:
845-398-7066
Provider Enumeration Date:
06/25/2012

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: 2084P0800X , with the licence number:  279334 , 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)





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