Healthcare Provider Details

I. General information

NPI: 1194098954
Provider Name (Legal Business Name): ALFRED CASTILLO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE SUITE B
BROOKLYN NY
11215-7247
US

IV. Provider business mailing address

263 7TH AVE STE 2B
BROOKLYN NY
11215-3693
US

V. Phone/Fax

Practice location:
  • Phone: 718-246-8700
  • Fax:
Mailing address:
  • Phone: 718-246-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number281589
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: