Provider Demographics
NPI:1538751177
Name:CELESTE MEDICAL, PLLC
Entity type:Organization
Organization Name:CELESTE MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DECASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:551-204-2543
Mailing Address - Street 1:154 ORANGEBURGH RD
Mailing Address - Street 2:
Mailing Address - City:OLD TAPPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-7499
Mailing Address - Country:US
Mailing Address - Phone:551-204-2543
Mailing Address - Fax:718-220-2434
Practice Address - Street 1:3010 GRAND CONCOURSE APT L3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-1534
Practice Address - Country:US
Practice Address - Phone:718-220-2433
Practice Address - Fax:718-220-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-05
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain