Provider Demographics
NPI:1245220334
Name:CASTELLINO, ANTHONY (DC, CCSP)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:CASTELLINO
Suffix:
Gender:M
Credentials:DC, CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 ATLANTA ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5806
Mailing Address - Country:US
Mailing Address - Phone:631-968-5780
Mailing Address - Fax:631-968-8366
Practice Address - Street 1:86 ATLANTA ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-5806
Practice Address - Country:US
Practice Address - Phone:631-968-8300
Practice Address - Fax:631-968-8366
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005682-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX48721Medicare PIN