Provider Demographics
NPI:1336122548
Name:CASTELLANO, BARTOLOMEO VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:BARTOLOMEO
Middle Name:VINCENT
Last Name:CASTELLANO
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 1:2052 RICHMOND ROAD SUITE
Mailing Address - Street 2:1C
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2149
Mailing Address - Country:US
Mailing Address - Phone:718-273-2626
Mailing Address - Fax:718-420-1289
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:1C
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2548
Practice Address - Country:US
Practice Address - Phone:718-273-2626
Practice Address - Fax:718-420-1289
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143837207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40D901Medicare ID - Type Unspecified
NYA62646Medicare UPIN