MEDICARE: MR. OMAR ALEXANDER CASTILLO JR. LMSW

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	104100000X	Social Worker	105355	NY

General Provider Information

NPI Number	:	1548627730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. OMAR ALEXANDER CASTILLO JR. LMSW

Provider Business Mailing Address
First Line	:	MOUNT SINAI HOSPITAL, 1 GUSTAVE L. LEVY PLACE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	347-882-1422
Fax Number	:

Provider Business Practice Location Address
First Line	:	3160 21ST ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-4520
Country	:	US
Telephone Number	:	347-882-1422
Fax Number	:

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

Provider Enumeration Date	:	01/20/2016
Last Update Date	:	05/06/2019

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Directions to “ MR. OMAR ALEXANDER CASTILLO JR. LMSW” Practice Location

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