Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 44562 | NY |
NPI | 1013939164 |
---|---|
Provider Name | Yiselle Zenit Castillo |
First Address | Roslyn, NY 11576-2301 |
Second Address | New York, NY 10016-6004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |