Provider Demographics
NPI:1093972812
Name:CASTILLON, ERMANY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:ERMANY
Middle Name:
Last Name:CASTILLON
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-2412
Mailing Address - Country:US
Mailing Address - Phone:718-589-4541
Mailing Address - Fax:718-893-8511
Practice Address - Street 1:1070 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-2412
Practice Address - Country:US
Practice Address - Phone:718-589-4541
Practice Address - Fax:718-893-8511
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011365OtherNEW YORK STATE LICENSE NUMBER