Provider Demographics
NPI:1144286782
Name:CANTU, ROBERTO JR (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:CANTU
Suffix:JR
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 1:14601 45TH AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2200
Mailing Address - Country:US
Mailing Address - Phone:718-670-3135
Mailing Address - Fax:718-670-4449
Practice Address - Street 1:146-01 45 AVENUE
Practice Address - Street 2:ROOM 211
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355
Practice Address - Country:US
Practice Address - Phone:718-670-5775
Practice Address - Fax:718-321-6141
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-22
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169342208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01046551Medicaid
NY01046551Medicaid
NY0105NTMedicare ID - Type Unspecified