Provider Demographics
NPI:1043766694
Name:TELLO-CASTILLO, FREDY
Entity Type:Individual
Prefix:
First Name:FREDY
Middle Name:
Last Name:TELLO-CASTILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 WATER STREET, 8TH FL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10005
Mailing Address - Country:US
Mailing Address - Phone:718-350-9591
Mailing Address - Fax:
Practice Address - Street 1:77 WATER STREET, 8TH FL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005
Practice Address - Country:US
Practice Address - Phone:718-350-9591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYB02787344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi