Provider Demographics
NPI:1770664294
Name:CASTILLO, RAPHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAPHAEL
Middle Name:A
Last Name:CASTILLO
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:PO BOX 3234
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10008-3234
Mailing Address - Country:US
Mailing Address - Phone:646-267-2300
Mailing Address - Fax:212-269-2901
Practice Address - Street 1:125 W 79TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6454
Practice Address - Country:US
Practice Address - Phone:212-785-1059
Practice Address - Fax:212-269-2901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232065-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
468A76U251Medicare PIN
NYI03949Medicare UPIN
NY46A571Medicare ID - Type Unspecified