Provider Demographics
NPI:1225222169
Name:RICHARD S CASTALDO MD, PC
Entity Type:Organization
Organization Name:RICHARD S CASTALDO MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CASTALDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-743-5450
Mailing Address - Street 1:533 NIAGARA ST
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-1810
Mailing Address - Country:US
Mailing Address - Phone:716-743-5450
Mailing Address - Fax:716-743-5455
Practice Address - Street 1:533 NIAGARA ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-1810
Practice Address - Country:US
Practice Address - Phone:716-743-5450
Practice Address - Fax:716-743-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188421-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01343911Medicaid
NYGRP512142001OtherBLUE CROSS
NY11750AMedicare PIN
NYCB4744Medicare PIN