Provider Demographics
NPI:1821581141
Name:GASTANES, CARL SALERA (NP)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:SALERA
Last Name:GASTANES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:JENEFER CARLITO
Other - Middle Name:SALERA
Other - Last Name:GASTANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, BSN, MSN, FNP
Mailing Address - Street 1:953 SOUTHERN BLVD RM 202
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-3428
Mailing Address - Country:US
Mailing Address - Phone:718-589-4541
Mailing Address - Fax:718-893-8511
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:718-838-0792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF342291-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty