Provider Demographics
NPI:1992324099
Name:SANTANA ALCANTARA, LUIS ENERIO (MD)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ENERIO
Last Name:SANTANA 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 1:1276 FULTON AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3467
Mailing Address - Country:US
Mailing Address - Phone:646-465-2947
Mailing Address - Fax:718-901-8589
Practice Address - Street 1:1276 FULTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:718-901-6484
Practice Address - Fax:718-901-8589
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP102961208D00000X
NY1992324099207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice