Healthcare Provider Details

I. General information

NPI: 1679936991
Provider Name (Legal Business Name): KIRKLAND CASTELLANO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S BROADWAY STE 201
TARRYTOWN NY
10591-4504
US

IV. Provider business mailing address

200 S BROADWAY STE 201
TARRYTOWN NY
10591-4504
US

V. Phone/Fax

Practice location:
  • Phone: 914-631-7300
  • Fax:
Mailing address:
  • Phone: 914-631-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME144137
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number308264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: