Healthcare Provider Details

I. General information

NPI: 1083543847
Provider Name (Legal Business Name): EMAUS SPECIALTY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 VILLA PL
NUTLEY NJ
07110-1919
US

IV. Provider business mailing address

19 VILLA PL
NUTLEY NJ
07110-1919
US

V. Phone/Fax

Practice location:
  • Phone: 516-312-8448
  • Fax:
Mailing address:
  • Phone: 516-312-8448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: EMAUS SANTIAGO
Title or Position: PA/OWNER
Credential: PA
Phone: 516-312-8448