Provider Demographics
NPI:1508137803
Name:LUIS MENDEZ CASTELLANOS MD PC
Entity Type:Organization
Organization Name:LUIS MENDEZ CASTELLANOS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAFAEL
Authorized Official - Last Name:MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-740-8231
Mailing Address - Street 1:336 FORT WASHINGTON AVE
Mailing Address - Street 2:SUITE 1-F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6803
Mailing Address - Country:US
Mailing Address - Phone:212-740-8231
Mailing Address - Fax:212-740-3420
Practice Address - Street 1:336 FORT WASHINGTON AVE
Practice Address - Street 2:SUITE 1-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-6803
Practice Address - Country:US
Practice Address - Phone:212-740-8231
Practice Address - Fax:212-740-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196245261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care