Healthcare Provider Details

I. General information

NPI: 1598763963
Provider Name (Legal Business Name): AUGUSTO ADOLFO CASTRILLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 26TH ST
NEW YORK NY
10001-6975
US

IV. Provider business mailing address

160 W 26TH ST
NEW YORK NY
10001-6975
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax:
Mailing address:
  • Phone: 212-924-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK2192
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number235065
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: