Healthcare Provider Details

I. General information

NPI: 1831119429
Provider Name (Legal Business Name): LESLEY ANNE SANTIAGO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 S ASHBY AVE
LIVINGSTON NJ
07039-2803
US

IV. Provider business mailing address

27 S ASHBY AVE
LIVINGSTON NJ
07039-2803
US

V. Phone/Fax

Practice location:
  • Phone: 973-994-1320
  • Fax:
Mailing address:
  • Phone: 973-994-1320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number40QA01548100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number027323
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: