Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | 149262 | NY |
NPI | 1114948577 |
---|---|
Provider Name | Mariano Salvador Castro-Magana |
First Address | Mineola, NY 11501-3808 |
Second Address | Mineola, NY 11501-4073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 02/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01240344 | (05) | NY |
B19315 | (02) | NY |