Healthcare Provider Details

I. General information

NPI: 1235950809
Provider Name (Legal Business Name): AIDA JULIE SANTIAGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROSPECT AVE
HACKENSACK NJ
07601-1997
US

IV. Provider business mailing address

833 RIVER DR
ELMWOOD PARK NJ
07407-1021
US

V. Phone/Fax

Practice location:
  • Phone: 201-343-6676
  • Fax: 201-343-6695
Mailing address:
  • Phone: 973-356-1653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15155100
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: