Provider Demographics
NPI:1467510859
Name:CASTILLO, ELMA DEVILLA (MD)
Entity Type:Individual
Prefix:
First Name:ELMA
Middle Name:DEVILLA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST NEW YORK
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-869-4044
Mailing Address - Fax:201-869-4105
Practice Address - Street 1:5801 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-2719
Practice Address - Country:US
Practice Address - Phone:201-869-4044
Practice Address - Fax:201-869-4105
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA548242080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine