Healthcare Provider Details

I. General information

NPI: 1124232863
Provider Name (Legal Business Name): ALTAMIRA MEDICAL DIAGNOSTIC AND MANAGEMENT, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6332 99TH ST
REGO PARK NY
11374-1941
US

IV. Provider business mailing address

6332 99TH ST
REGO PARK NY
11374-1941
US

V. Phone/Fax

Practice location:
  • Phone: 718-275-4141
  • Fax:
Mailing address:
  • Phone: 718-275-4141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number115871
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number115871
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number115871
License Number StateNY

VIII. Authorized Official

Name: JUAN A ALEMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-275-4141