Provider Demographics
NPI:1649255365
Name:RICHMOND OTOLARYNGOLOGY GROUP PC
Entity type:Organization
Organization Name:RICHMOND OTOLARYNGOLOGY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARTOLOMEO
Authorized Official - Middle Name:V
Authorized Official - Last Name:CASTELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-2626
Mailing Address - Street 1:78 TODT HILL RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4528
Mailing Address - Country:US
Mailing Address - Phone:718-273-2626
Mailing Address - Fax:718-442-4295
Practice Address - Street 1:78 TODT HILL RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4528
Practice Address - Country:US
Practice Address - Phone:718-273-2626
Practice Address - Fax:718-442-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40D901Medicare PIN