Healthcare Provider Details

I. General information

NPI: 1508137803
Provider Name (Legal Business Name): LUIS MENDEZ CASTELLANOS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 01/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 FORT WASHINGTON AVE SUITE 1-F
NEW YORK NY
10033-6803
US

IV. Provider business mailing address

336 FORT WASHINGTON AVE SUITE 1-F
NEW YORK NY
10033-6803
US

V. Phone/Fax

Practice location:
  • Phone: 212-740-8231
  • Fax: 212-740-3420
Mailing address:
  • Phone: 212-740-8231
  • Fax: 212-740-3420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number196245
License Number StateNY

VIII. Authorized Official

Name: DR. LUIS RAFAEL MENDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 212-740-8231