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General NPI Number Information
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NPI Number | 1508137803
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Entity Type | Organization
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Legal Business Name | LUIS MENDEZ CASTELLANOS MD PC
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Dates
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Enumeration Date | 01/18/2012
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Last Update Date | 01/18/2012
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Provider Practice Location Address
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Address Line | 336 FORT WASHINGTON AVE SUITE 1-F
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City | NEW YORK
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State | NY
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Zip | 10033-6803
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Country | US
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Telephone | 212-740-8231
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Fax | 212-740-3420
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Provider Business Mailing Address
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Address Line | 336 FORT WASHINGTON AVE SUITE 1-F
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City | NEW YORK
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State | NY
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Zip | 10033-6803
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Country | US
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Telephone | 212-740-8231
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Fax | 212-740-3420
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LUIS RAFAEL MENDEZ
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Credential | MD
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Telephone | 212-740-8231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 196245
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License Number State | NY
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