Provider Demographics
NPI:1598763963
Name:CASTRILLON, AUGUSTO ADOLFO (MD)
Entity Type:Individual
Prefix:DR
First Name:AUGUSTO
Middle Name:ADOLFO
Last Name:CASTRILLON
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 1:160 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6975
Mailing Address - Country:US
Mailing Address - Phone:212-924-2510
Mailing Address - Fax:
Practice Address - Street 1:160 W 26TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6975
Practice Address - Country:US
Practice Address - Phone:212-924-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2192207Q00000X
NY235065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113558402Medicaid
TX180903001Medicaid
TX113558402Medicaid
TX180903001Medicaid