Provider Demographics
NPI:1154618262
Name:ALCARAZ ALVAREZ, JOSE LUIS
Entity type:Individual
Prefix:
First Name:JOSE LUIS
Middle Name:
Last Name:ALCARAZ ALVAREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4735
Mailing Address - Country:US
Mailing Address - Phone:347-589-2962
Mailing Address - Fax:
Practice Address - Street 1:78 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4735
Practice Address - Country:US
Practice Address - Phone:347-589-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-09
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271641208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist