Provider Demographics
NPI:1700961950
Name:BAQUIRAN, LESTRINO CACHOLA (MD)
Entity Type:Individual
Prefix:DR
First Name:LESTRINO
Middle Name:CACHOLA
Last Name:BAQUIRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6028
Mailing Address - Country:US
Mailing Address - Phone:212-721-8200
Mailing Address - Fax:212-721-0806
Practice Address - Street 1:50 CENTRAL PARK W
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6028
Practice Address - Country:US
Practice Address - Phone:212-721-8200
Practice Address - Fax:212-721-0806
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00194981Medicaid
NYB20475Medicare UPIN
NY00194981Medicaid