Healthcare Provider Details

I. General information

NPI: 1285257642
Provider Name (Legal Business Name): JAVIER ALEJANDRO CASTRO VALENZUELA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 ROOSEVELT AVE
CORONA NY
11368-2331
US

IV. Provider business mailing address

10211 ROOSEVELT AVE
CORONA NY
11368-2331
US

V. Phone/Fax

Practice location:
  • Phone: 718-898-5200
  • Fax: 718-898-1251
Mailing address:
  • Phone: 718-898-5200
  • Fax: 718-898-1251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number323894
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: