Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 253529 | NY |
Y | 111NI0900X | Internist | 253529 | NY |
N | 207RA0201X | Internist - Allergy & Immunology | 253529 | NY |
NPI | 1639216179 |
---|---|
Provider Name | Myrelle Baquiran Castro |
First Address | Goshen, NY 10924-6758 |
Second Address | Cornwall, NY 12518-1323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 27/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A400029004 | MEDICARE (01) |