Healthcare Provider Details

I. General information

NPI: 1710099585
Provider Name (Legal Business Name): SANTIAGO ALBERTO CENTURION M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3548 US HIGHWAY 9 STE 2
OLD BRIDGE NJ
08857-2963
US

IV. Provider business mailing address

3548 US HIGHWAY 9 STE 2
OLD BRIDGE NJ
08857-2963
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-6300
  • Fax: 732-679-9566
Mailing address:
  • Phone: 732-679-6300
  • Fax: 732-679-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA866380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number25MA07649600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA866380
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA07649600
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number25MA07649600
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number231911-1
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number231911-1
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number231911-1
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA866380
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: