Provider Demographics
NPI:1750458360
Name:ALCASID-ESCANO, MARIA-LOURDES SABATER (MD)
Entity Type:Individual
Prefix:
First Name:MARIA-LOURDES
Middle Name:SABATER
Last Name:ALCASID-ESCANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 ROANOKE AVE
Mailing Address - Street 2:P. O. BOX 809
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2731
Mailing Address - Country:US
Mailing Address - Phone:631-727-3141
Mailing Address - Fax:631-727-3364
Practice Address - Street 1:982 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2731
Practice Address - Country:US
Practice Address - Phone:631-727-3141
Practice Address - Fax:631-727-3364
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY110525-1207K00000X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08953Medicare UPIN
NY348351Medicare ID - Type Unspecified