MEDICARE: MR. JASON A SANTIAGO PA

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	363A00000X	Physician Assistant	010584	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	061018000088	OTHER	NY	FIDELIS
2	9512962	OTHER	NY	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1568450989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON A SANTIAGO PA

Provider Business Mailing Address
First Line	:	3980 SHERIDAN DR
Second Line	:	SUITE 600
City	:	AMHERST
State	:	NY
Zip	:	14226-1727
Country	:	US
Telephone Number	:	716-250-2000
Fax Number	:	716-250-2040

Provider Business Practice Location Address
First Line	:	3980 SHERIDAN DR
Second Line	:	SUITE 200
City	:	AMHERST
State	:	NY
Zip	:	14226-1727
Country	:	US
Telephone Number	:	716-250-2000
Fax Number	:	716-636-1365

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

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. JASON A SANTIAGO PA” Practice Location

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