Healthcare Provider Details

I. General information

NPI: 1063584670
Provider Name (Legal Business Name): EMELITA RIEGO DE DIOS CASTOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 FOREST AVE
STATEN ISLAND NY
10303-1737
US

IV. Provider business mailing address

26 CROTON AVE
STATEN ISLAND NY
10301-3331
US

V. Phone/Fax

Practice location:
  • Phone: 718-761-2060
  • Fax: 718-982-7647
Mailing address:
  • Phone: 718-273-8714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number141469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: