Provider Demographics
NPI:1114404647
Name:CASTILLO, ANLLY J
Entity Type:Individual
Prefix:
First Name:ANLLY
Middle Name:J
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 YELLOWSTONE BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2836
Mailing Address - Country:US
Mailing Address - Phone:347-744-3978
Mailing Address - Fax:
Practice Address - Street 1:6770 YELLOWSTONE BLVD APT C
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2836
Practice Address - Country:US
Practice Address - Phone:347-744-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1240989181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist