Provider Demographics
NPI:1407667629
Name:ALCANTARA, GERSON
Entity type:Individual
Prefix:MR
First Name:GERSON
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GERSON
Other - Middle Name:
Other - Last Name:ALCANTARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSOM DACM LAC
Mailing Address - Street 1:2385 BARKER AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7790
Mailing Address - Country:US
Mailing Address - Phone:646-286-5221
Mailing Address - Fax:
Practice Address - Street 1:2385 BARKER AVE APT 6D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7790
Practice Address - Country:US
Practice Address - Phone:646-286-5221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007665171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist