Provider Demographics
NPI:1164513891
Name:CASTELLO, ANGELO (DC)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:
Last Name:CASTELLO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 IBM RD
Mailing Address - Street 2:STE 105
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-5461
Mailing Address - Country:US
Mailing Address - Phone:845-462-8200
Mailing Address - Fax:
Practice Address - Street 1:26 IBM RD
Practice Address - Street 2:SUITE 105
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5427
Practice Address - Country:US
Practice Address - Phone:845-462-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004834-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX27821Medicare PIN