Provider Demographics
NPI:1700172582
Name:CAST A FOOT PODIATRY PC
Entity Type:Organization
Organization Name:CAST A FOOT PODIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-685-8405
Mailing Address - Street 1:474 FULTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-4101
Mailing Address - Country:US
Mailing Address - Phone:516-493-9999
Mailing Address - Fax:
Practice Address - Street 1:474 FULTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-4101
Practice Address - Country:US
Practice Address - Phone:516-493-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006326213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty