Healthcare Provider Details

I. General information

NPI: 1013939164
Provider Name (Legal Business Name): YISELLE ZENIT CASTILLO D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 32ND ST SUITE 103
NEW YORK NY
10016-6004
US

IV. Provider business mailing address

110 CHESTNUT DR
ROSLYN NY
11576-2301
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-3328
  • Fax: 212-683-0021
Mailing address:
  • Phone: 516-801-0787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number44562
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: