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General NPI Number Information
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NPI Number | 1538751177
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Entity Type | Organization
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Legal Business Name | CELESTE MEDICAL, PLLC
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Dates
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Enumeration Date | 02/05/2021
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 3010 GRAND CONCOURSE APT L3
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City | BRONX
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State | NY
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Zip | 10458-1534
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Country | US
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Telephone | 718-220-2433
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Fax | 718-220-2433
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Provider Business Mailing Address
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Address Line | 154 ORANGEBURGH RD
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City | OLD TAPPAN
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State | NJ
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Zip | 07675-7499
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Country | US
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Telephone | 551-204-2543
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Fax | 718-220-2434
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLARICIO DECASTRO
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Credential | MD
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Telephone | 551-204-2543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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