Provider Demographics
NPI:1902893100
Name:CASTALDO, ILENE SUE (NP C)
Entity Type:Individual
Prefix:MRS
First Name:ILENE
Middle Name:SUE
Last Name:CASTALDO
Suffix:
Gender:F
Credentials:NP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FARM MEADOW LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-2100
Mailing Address - Country:US
Mailing Address - Phone:845-220-8331
Mailing Address - Fax:
Practice Address - Street 1:2070 ROUTE 52
Practice Address - Street 2:
Practice Address - City:EAST FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12533-3507
Practice Address - Country:US
Practice Address - Phone:845-894-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3344901363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02635129Medicaid
Q33060Medicare UPIN
NY02635129Medicaid