Provider Demographics
NPI:1609106814
Name:STEPHEN CASTORINO MD PC
Entity Type:Organization
Organization Name:STEPHEN CASTORINO MD PC
Other - Org Name:ADVANCED HEALTH & AGE REJUVENATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CASTORINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-368-2244
Mailing Address - Street 1:1930 VILLAGE CENTER CIR # 3-633
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6299
Mailing Address - Country:US
Mailing Address - Phone:702-368-2244
Mailing Address - Fax:702-368-2242
Practice Address - Street 1:653 N TOWN CENTER DR STE 407
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0505
Practice Address - Country:US
Practice Address - Phone:702-368-2244
Practice Address - Fax:702-368-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVCX590AMedicare PIN