Provider Demographics
NPI:1417957572
Name:CASTELLANO, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
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 1:201 E 19TH STREET
Mailing Address - Street 2:SUITE 10F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-255-5690
Mailing Address - Fax:212-604-1115
Practice Address - Street 1:13 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6847
Practice Address - Country:US
Practice Address - Phone:212-995-6642
Practice Address - Fax:212-604-1115
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704287Medicaid
F55073Medicare UPIN
NY01704287Medicaid