Healthcare Provider Details

I. General information

NPI: 1861553935
Provider Name (Legal Business Name): SERGIO ALCUAZ AGUILAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 06 WEXFORD TERRACE
JAMAICA ESTATES NY
11432
US

IV. Provider business mailing address

17521 88TH AVE # OLP1
JAMAICA NY
11432-5758
US

V. Phone/Fax

Practice location:
  • Phone: 718-291-9384
  • Fax: 718-558-9020
Mailing address:
  • Phone: 718-291-9384
  • Fax: 718-558-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number121316
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: