MEDICARE: LAURA JULIANA CASTELLANOS REYES MD

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	2080P0210X	Pediatric Nephrology Physician	276856	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811231806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA JULIANA CASTELLANOS REYES MD

Provider Business Mailing Address
First Line	:	1 GUSTAVE L LEVY PLACE, BOX 1664
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029
Country	:	US
Telephone Number	:	212-241-6187
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 GUSTAVE L LEVY PL # 1664
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-6504
Country	:	US
Telephone Number	:	212-241-6187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/25/2025

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