Healthcare Provider Details

I. General information

NPI: 1497750848
Provider Name (Legal Business Name): JOSE SANTANA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 70TH ST
GUTTENBERG NJ
07093-2417
US

IV. Provider business mailing address

PO BOX 2566
GUTTENBERG NJ
07093-0641
US

V. Phone/Fax

Practice location:
  • Phone: 201-854-0055
  • Fax: 201-854-2633
Mailing address:
  • Phone: 201-854-0055
  • Fax: 201-854-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA05225300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: