MEDICARE: YERIKO SANTILLAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	309809	NY

General Provider Information

NPI Number	:	1427552611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YERIKO SANTILLAN MD

Provider Business Mailing Address
First Line	:	1000 10TH AVE STE 11A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-1147
Country	:	US
Telephone Number	:	212-523-3454
Fax Number	:

Provider Business Practice Location Address
First Line	:	2771 FREDERICK DOUGLASS BLVD
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10039-3027
Country	:	US
Telephone Number	:	212-690-0303
Fax Number	:	212-636-3000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2018
Last Update Date	:	05/12/2021

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