Provider Demographics
NPI:1457491961
Name:MENDEZ-CASTELLANOS, LUIS RAFAEL (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAFAEL
Last Name:MENDEZ-CASTELLANOS
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 1:336 FORT WASHINGTON AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6804
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195245207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02079436Medicaid
NY742141Medicare ID - Type Unspecified
NY02079436Medicaid