Healthcare Provider Details

I. General information

NPI: 1568381549
Provider Name (Legal Business Name): SIDNEY G CASTIBLANCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 PRATT AVE
BAYSIDE NY
11359-1119
US

IV. Provider business mailing address

9 METROTECH CTR
BROOKLYN NY
11201-5431
US

V. Phone/Fax

Practice location:
  • Phone: 718-281-8325
  • Fax:
Mailing address:
  • Phone: 718-999-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number187243
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: