MEDICARE: DR. LEE W CASTELLAN D.C., CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	010730	NY
2	111N00000X	Chiropractor	38MC00665200	NJ
3	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	010730	OTHER	NY	STATE LICENSE NUMBER
2	38MC00665200	OTHER	NJ	NJ LIC.

General Provider Information

NPI Number	:	1366442311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE W CASTELLAN D.C., CNIM

Provider Business Mailing Address
First Line	:	35 HICKORY CT
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1632
Country	:	US
Telephone Number	:	718-605-7896
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 HICKORY CT
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-1632
Country	:	US
Telephone Number	:	718-605-7896
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/23/2011

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