Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 047884 | CT |
N | 2080A0000X | Adolescent Medicine | 265887 | NY |
NPI | 1083828032 |
---|---|
Provider Name | Marigold C Castillo |
First Address | Bayside, NY 11361-2573 |
Second Address | Bayside, NY 11361-2573 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 12/12/2019 |