Healthcare Provider Details

I. General information

NPI: 1316074651
Provider Name (Legal Business Name): EDWIN SANTIAGO MIDWIFE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE 5TH FL OB GYN ADMINISTRATION
BRONX NY
10457-7606
US

IV. Provider business mailing address

21 UNION ST
RIDGEFIELD PARK NJ
07660-2220
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8383
  • Fax: 718-239-8360
Mailing address:
  • Phone: 718-239-8383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF000505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: