| Doctor Name: | DR. PROSPERO CENTENO SANIDAD |
| NPI Number: | 1134406424 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | 91297 |
| Business Practice Address: | 330 W 58th St 8c New York, NY - 10019 |
| Business Phone Number: | 2125828075 |
| Business Fax Number: | |
| Mailing Address: | 330 W 58th St 8c, NY |
| State: | NY |
| Postal Code: | 10019 |
| Phone Number: | 2125828075 |
| Fax Number: | |
| NPI Enumeration Date: | 11/15/2011 |
| NPI Last Update Date: | 11/15/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 91297 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |