Individual
MS. STACIE K CASTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
2001 MARCUS AVE, SUITE N220, LAKE SUCCESS, NY 11042
(516) 652-2747
(516) 935-2058
Mailing address
62 FORSYTHIA LANE, JERICHO, NY 11753
(516) 652-2747
(516) 935-2058
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
0023311
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9014E1
EMPIRE BLUE CROSS BLUE SHIELD
NY
01
—
P2035293003
UNITED HEALTHCARE
NY
01
—
P2576072
OXFORD
NY
Enumeration date
05/22/2007
Last updated
10/07/2011
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