Provider Demographics
NPI:1457497299
Name:C J M MEDICAL PC
Entity Type:Organization
Organization Name:C J M MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASTINE, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-561-1321
Mailing Address - Street 1:135 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-4706
Mailing Address - Country:US
Mailing Address - Phone:518-561-1321
Mailing Address - Fax:518-561-3206
Practice Address - Street 1:135 S PERU ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-4706
Practice Address - Country:US
Practice Address - Phone:518-561-1321
Practice Address - Fax:518-561-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
55575AMedicare ID - Type Unspecified