MEDICARE: CELESTE MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1538751177
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CELESTE MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	154 ORANGEBURGH RD
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7499
Country	:	US
Telephone Number	:	551-204-2543
Fax Number	:	718-220-2434

Provider Business Practice Location Address
First Line	:	3010 GRAND CONCOURSE APT L3
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-1534
Country	:	US
Telephone Number	:	718-220-2433
Fax Number	:	718-220-2433

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLARICIO DECASTRO
Credential	:	MD
Telephone Number	:	551-204-2543

Provider Enumeration Date	:	02/05/2021
Last Update Date	:	02/05/2021

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