Healthcare Provider Details

I. General information

NPI: 1316567712
Provider Name (Legal Business Name): STEVEN JAMES SANTOS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 04/26/2020
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 WATERBURY AVE
BRONX NY
10462-5510
US

IV. Provider business mailing address

1724 EDISON AVE
BRONX NY
10461-4806
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-1830
  • Fax:
Mailing address:
  • Phone: 646-382-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: