Provider Demographics
NPI:1033212816
Name:DECASTRO, ANGELINA REPEROGA (MD)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:REPEROGA
Last Name:DECASTRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193-04 HORACE HARDING EXPWY #3G
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3540
Mailing Address - Country:US
Mailing Address - Phone:917-817-4836
Mailing Address - Fax:718-445-6545
Practice Address - Street 1:36A GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-2000
Practice Address - Country:US
Practice Address - Phone:917-817-4836
Practice Address - Fax:718-445-6545
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1649082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry