Provider Demographics
NPI:1366442311
Name:CASTELLAN, LEE W (DC, CNIM)
Entity Type:Individual
Prefix:DR
First Name:LEE
Middle Name:W
Last Name:CASTELLAN
Suffix:
Gender:M
Credentials:DC, CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HICKORY CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-1632
Mailing Address - Country:US
Mailing Address - Phone:718-605-7896
Mailing Address - Fax:
Practice Address - Street 1:35 HICKORY CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-1632
Practice Address - Country:US
Practice Address - Phone:718-605-7896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010730111N00000X
NJ38MC00665200111N00000X
246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY010730OtherSTATE LICENSE NUMBER
NJ38MC00665200OtherNJ LIC.
NY1198437Medicare UPIN