MEDICARE: RICHMOND OTOLARYNGOLOGY GROUP PC

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	207Y00000X	Otolaryngology Physician

General Provider Information

NPI Number	:	1649255365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHMOND OTOLARYNGOLOGY GROUP PC

Provider Business Mailing Address
First Line	:	78 TODT HILL RD
Second Line	:	SUITE 204
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4528
Country	:	US
Telephone Number	:	718-273-2626
Fax Number	:	718-442-4295

Provider Business Practice Location Address
First Line	:	78 TODT HILL RD
Second Line	:	SUITE 204
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-4528
Country	:	US
Telephone Number	:	718-273-2626
Fax Number	:	718-442-4295

Authorized Official
Title or Position	:	VICE-PRESIDENT
Name	:	DR. BARTOLOMEO V. CASTELLANO
Credential	:	M.D.
Telephone Number	:	718-273-2626

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/07/2014

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