=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841323037
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK J CASTIGLIONE D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SARA CT
-----------------------------------------------------
City | NESCONSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11767-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-265-5949
-----------------------------------------------------
Fax | 631-265-5948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 SARA CT
-----------------------------------------------------
City | NESCONSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11767-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-265-5949
-----------------------------------------------------
Fax | 631-265-5948
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X005896-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------