Healthcare Provider Details

I. General information

NPI: 1891277901
Provider Name (Legal Business Name): ARLENE JUDY SANTIAGO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 09/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2573 49TH ST
ASTORIA NY
11103-1120
US

IV. Provider business mailing address

2573 49TH ST
ASTORIA NY
11103-1120
US

V. Phone/Fax

Practice location:
  • Phone: 917-686-2677
  • Fax:
Mailing address:
  • Phone: 917-686-2677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF308890-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: