Provider Demographics
NPI:1326281957
Name:ANGEL ALCANTARA, M.D., P.C.
Entity Type:Organization
Organization Name:ANGEL ALCANTARA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALCANTARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-928-5959
Mailing Address - Street 1:130 WADSWORTH AVE
Mailing Address - Street 2:4
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-4814
Mailing Address - Country:US
Mailing Address - Phone:212-928-5959
Mailing Address - Fax:212-928-5189
Practice Address - Street 1:130 WADSWORTH AVE
Practice Address - Street 2:4
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-4814
Practice Address - Country:US
Practice Address - Phone:212-928-5959
Practice Address - Fax:212-928-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2145352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086322Medicaid
NYH18456Medicare UPIN
NY02086322Medicaid