Provider Demographics
NPI:1538645841
Name:ALCALA ZERMENO, JUAN LUIS (MD)
Entity type:Individual
Prefix:
First Name:JUAN LUIS
Middle Name:
Last Name:ALCALA ZERMENO
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 1:710 W 168TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2699
Mailing Address - Country:US
Mailing Address - Phone:212-342-4426
Mailing Address - Fax:212-305-3790
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2699
Practice Address - Country:US
Practice Address - Phone:646-426-3876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29109207R00000X
PAMT2268602084N0400X
PAMD4792892084N0400X
MN298092084N0400X
MN664852084N0400X
NY3301092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine