Provider Demographics
NPI:1982800439
Name:CASTLE OF HEALTH MEDICAL OFFICE, P.C.
Entity Type:Organization
Organization Name:CASTLE OF HEALTH MEDICAL OFFICE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YUAN
Authorized Official - Middle Name:YI
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-358-6768
Mailing Address - Street 1:45 N CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1013
Mailing Address - Country:US
Mailing Address - Phone:718-358-6768
Mailing Address - Fax:718-358-6783
Practice Address - Street 1:3916 PRINCE ST STE 351
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5361
Practice Address - Country:US
Practice Address - Phone:718-358-6768
Practice Address - Fax:718-358-6783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2016-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232861261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596647Medicaid
NYI22898Medicare UPIN
NY02596647Medicaid