Healthcare Provider Details

I. General information

NPI: 1659922540
Provider Name (Legal Business Name): RYAN S SANTORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 HARVEY RD
LONDONDERRY NH
03053-7449
US

IV. Provider business mailing address

21 AVONDALE DR
CENTEREACH NY
11720-2837
US

V. Phone/Fax

Practice location:
  • Phone: 800-657-6517
  • Fax:
Mailing address:
  • Phone: 631-721-7579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number044570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: