Provider Demographics
NPI:1932184314
Name:CASTIEL, MERCEDES (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:CASTIEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1481 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-3607
Mailing Address - Country:US
Mailing Address - Phone:917-374-1892
Mailing Address - Fax:
Practice Address - Street 1:87 WOLFS LN
Practice Address - Street 2:
Practice Address - City:PELHAM
Practice Address - State:NY
Practice Address - Zip Code:10803-1831
Practice Address - Country:US
Practice Address - Phone:917-374-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201608207VG0400X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
F60895Medicare UPIN
26G151Medicare ID - Type Unspecified