Provider Demographics
NPI:1982756193
Name:ALCANTARA/POLANCO, ROBINSON HUMBERTO (MD)
Entity Type:Individual
Prefix:
First Name:ROBINSON
Middle Name:HUMBERTO
Last Name:ALCANTARA/POLANCO
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 1:175 NAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-6001
Mailing Address - Country:US
Mailing Address - Phone:212-544-2001
Mailing Address - Fax:212-544-2007
Practice Address - Street 1:175 NAGLE AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-6001
Practice Address - Country:US
Practice Address - Phone:212-544-2001
Practice Address - Fax:212-544-2007
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178260207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE20002Medicare UPIN