Provider Demographics
NPI:1194831610
Name:CASTELLANOS, ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:CASTELLANOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 KENNEDY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1435
Mailing Address - Country:US
Mailing Address - Phone:607-756-9941
Mailing Address - Fax:607-756-2907
Practice Address - Street 1:14 KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1435
Practice Address - Country:US
Practice Address - Phone:607-756-9941
Practice Address - Fax:607-756-2907
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042259Medicaid
NY0931960001Medicare NSC
NYB80936Medicare UPIN
NY53188AMedicare PIN