Individual
JONATHAN MANUEL PEREZ CASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2570 ROUTE 9W, CORNWALL, NY 12518-1323
(845) 651-1400
(845) 651-1512
Mailing address
2 COATES DR, GOSHEN, NY 10924-6758
(845) 651-1400
(845) 651-1512
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
002190
NY
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
253533
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00472931
—
NY
01
—
331832
MEDICARE
—
01
—
A400036561
MEDICARE
—
Enumeration date
08/31/2005
Last updated
09/27/2012
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