Provider Demographics
NPI:1962618934
Name:VALENCIA-CASTILLO, ALICE O (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:O
Last Name:VALENCIA-CASTILLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GUION PL
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5502
Mailing Address - Country:US
Mailing Address - Phone:914-493-8558
Mailing Address - Fax:914-493-1488
Practice Address - Street 1:95 GRASSLANDS RD
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1646
Practice Address - Country:US
Practice Address - Phone:914-493-8558
Practice Address - Fax:914-493-1488
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2274052080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02395182Medicaid
NY0030MEA201Medicare PIN
NY0030M1Medicare PIN
NY02395182Medicaid
NYI00270Medicare UPIN