1679079750 NPI number — MR. ZAHEDI MANUEL CASTILLO MHC

Table of content: MR. ZAHEDI MANUEL CASTILLO MHC (NPI 1679079750)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679079750 NPI number — MR. ZAHEDI MANUEL CASTILLO MHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASTILLO
Provider First Name:
ZAHEDI
Provider Middle Name:
MANUEL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MHC
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:
1679079750
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1453 WALTON AVE APT 3A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10452-6535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-576-4638
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4511 3RD AVE FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-951-6352
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2018

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: 101YM0800X , 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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