Provider Demographics
NPI:1669882288
Name:CASTILLO, MARY I
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:I
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 ORCHARD ST
Mailing Address - Street 2:2N
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10703-2834
Mailing Address - Country:US
Mailing Address - Phone:914-457-3801
Mailing Address - Fax:
Practice Address - Street 1:148 ORCHARD ST
Practice Address - Street 2:2N
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10703-2834
Practice Address - Country:US
Practice Address - Phone:914-457-3801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY314000-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse