Individual
KIM DECASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP, CNM
Contact information
Practice address
118 N COUNTRY RD, PORT JEFFERSON, NY 11777-2120
(631) 473-7171
Mailing address
118 N COUNTRY RD, PORT JEFFERSON, NY 11777-2120
(631) 473-7171
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F360326-1
NY
367A00000X
Advanced Practice Midwife
F000792-1
NY
Other
Enumeration date
12/26/2006
Last updated
06/29/2011
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