Provider Demographics
NPI:1053041483
Name:CASTILLO, ELLINGTON
Entity Type:Individual
Prefix:
First Name:ELLINGTON
Middle Name:
Last Name: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 1:214 PRICE AVE APT I13
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1836
Mailing Address - Country:US
Mailing Address - Phone:646-806-4099
Mailing Address - Fax:
Practice Address - Street 1:214 PRICE AVE APT I13
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1836
Practice Address - Country:US
Practice Address - Phone:646-806-4099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health