Provider Demographics
NPI:1104143056
Name:CASTRO, MARTHA (PA-C)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 WATERS PL
Mailing Address - Street 2:SUITE 903
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2720
Mailing Address - Country:US
Mailing Address - Phone:718-652-0003
Mailing Address - Fax:718-652-0815
Practice Address - Street 1:1250 WATERS PL
Practice Address - Street 2:SUITE 903
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2720
Practice Address - Country:US
Practice Address - Phone:718-652-0003
Practice Address - Fax:718-652-0815
Is Sole Proprietor?:No
Enumeration Date:2010-04-30
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant