Healthcare Provider Details

I. General information

NPI: 1023684701
Provider Name (Legal Business Name): ANTHONY LOUIS CASTIGLIONE ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 WOLF HILL RD
DIX HILLS NY
11746-5633
US

IV. Provider business mailing address

260 3RD ST
SAINT JAMES NY
11780-2439
US

V. Phone/Fax

Practice location:
  • Phone: 631-592-3285
  • Fax:
Mailing address:
  • Phone: 631-428-4220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number003212
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: