Provider Demographics
NPI:1316981202
Name:ALCANTARA, ANGEL (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:ALCANTARA
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 1:2360 AMSTERDAM AVE
Mailing Address - Street 2:APT M2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-7364
Mailing Address - Country:US
Mailing Address - Phone:212-305-2330
Mailing Address - Fax:212-305-4724
Practice Address - Street 1:2360 AMSTERDAM AVE APT M2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-7364
Practice Address - Country:US
Practice Address - Phone:646-678-5222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2145352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02086322Medicaid
NYH18456Medicare UPIN
NY93M261Medicare ID - Type Unspecified