Provider Demographics
NPI:1417921081
Name:CASTELLANO, MICHAEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:CASTELLANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:501 SEAVIEW AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-3436
Mailing Address - Country:US
Mailing Address - Phone:718-226-9500
Mailing Address - Fax:718-226-5822
Practice Address - Street 1:501 SEAVIEW AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-9500
Practice Address - Fax:718-226-5822
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY209520208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02148621Medicaid
NY02148621Medicaid
NY2474H1Medicare PIN
H34401Medicare UPIN
NY651206220OtherHORIZON HEALTHCARE
NY02148621Medicaid
NYA400090901Medicare PIN
NY1751680OtherUNITED HEALTHCARE
NY4C7960OtherHEALTH NET
NY52842OtherGHI HMO
NJ651206220OtherHORIZON BC/BS OF NJ
NY2474H1Medicare PIN
NY9802783002OtherCIGNA
H34401Medicare UPIN
NY24336POtherHIP
NY651206220OtherHORIZON HEALTHCARE
NYMC02474H20OtherBLUE CROSS/BLUE SHIELD
NY02148621Medicaid
NY7586231OtherAETNA-US HEALTHCARE PPO
NYA400090901Medicare PIN