Provider Demographics
NPI:1528198124
Name:CASTILLO, HECTOR LUIS (MD)
Entity type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:LUIS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MADISON AVENUE
Mailing Address - Street 2:P.O. BOX 559, PARK STATION
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501-3655
Mailing Address - Country:US
Mailing Address - Phone:973-742-3937
Mailing Address - Fax:973-742-4411
Practice Address - Street 1:1000 MADISON AVE.
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501-3566
Practice Address - Country:US
Practice Address - Phone:973-742-3937
Practice Address - Fax:973-742-4411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41481207R00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ34D482HCOtherBLUE CROSS & BLUE SHIELD