Provider Demographics
NPI:1952389470
Name:CASTIGLIA, CAROLYN M (DO)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:CASTIGLIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4042A AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLAND PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11558-1226
Mailing Address - Country:US
Mailing Address - Phone:516-670-8800
Mailing Address - Fax:516-670-8803
Practice Address - Street 1:4042A AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:ISLAND PARK
Practice Address - State:NY
Practice Address - Zip Code:11558-1226
Practice Address - Country:US
Practice Address - Phone:516-670-8800
Practice Address - Fax:516-670-8803
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951922Medicaid
NY11V561Medicare ID - Type Unspecified
NY01951922Medicaid