Provider Demographics
NPI:1871763128
Name:ALCINDOR, PATRICK E
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:E
Last Name:ALCINDOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 BROADWAY AVE
Mailing Address - Street 2:3RD FLR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6002
Mailing Address - Country:US
Mailing Address - Phone:646-787-6436
Mailing Address - Fax:
Practice Address - Street 1:2175 HUDSON TER APT 1G
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7704
Practice Address - Country:US
Practice Address - Phone:646-787-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041631183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02889018Medicaid