Provider Demographics
NPI:1235142498
Name:SOTO-ALCANTARA, LILLIAM A (MD MPH)
Entity Type:Individual
Prefix:
First Name:LILLIAM
Middle Name:A
Last Name:SOTO-ALCANTARA
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:LILLIAM
Other - Middle Name:A
Other - Last Name:SOTO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6124 136TH ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367
Mailing Address - Country:US
Mailing Address - Phone:718-463-1932
Mailing Address - Fax:
Practice Address - Street 1:9020 ELMHURST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-457-7220
Practice Address - Fax:718-397-1115
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01985771Medicaid
NY03886Medicare ID - Type Unspecified
H09505Medicare UPIN