Healthcare Provider Details

I. General information

NPI: 1902851629
Provider Name (Legal Business Name): LOURDES CASTANEDA CASTILLO M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 SCHENECTADY AVE
BROOKLYN NY
11203-1809
US

IV. Provider business mailing address

585 SCHENECTADY AVE MANAGED CARE DEPT. - 6TH FLOOR, BLUMBERG BLDG.
BROOKLYN NY
11203-1809
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-5292
  • Fax: 718-604-5527
Mailing address:
  • Phone: 718-604-5469
  • Fax: 718-604-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number164898
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: