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General NPI Number Information
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NPI Number | 1851069256
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Entity Type | Individual
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Provider Name | KRISTEN MARIE CASTELLANO
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 27005 76TH AVE STE B235-G
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City | NEW HYDE PARK
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State | NY
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Zip | 11040-1402
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Country | US
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Telephone | 718-470-7820
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Fax |
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Provider Business Mailing Address
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Address Line | 94 JOLINE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10307-2019
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Country | US
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Telephone | 646-593-0852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 027929
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License Number State | NY
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