MEDICARE: DR. MARIO CASTELLANOS

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	207R00000X	Internal Medicine Physician	213339	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548243611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO CASTELLANOS

Provider Business Mailing Address
First Line	:	1 EDGEWATER ST
Second Line	:	6TH FLOOR - PAYER RELATIONS
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-4900
Country	:	US
Telephone Number	:	718-226-1008
Fax Number	:	718-226-1039

Provider Business Practice Location Address
First Line	:	242 MASON AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-3408
Country	:	US
Telephone Number	:	718-226-9464
Fax Number	:

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	02/04/2008

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