Healthcare Provider Details

I. General information

NPI: 1235106527
Provider Name (Legal Business Name): ALLAN R SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2006
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2091 NOSTRAND AVE
BROOKLYN NY
11210-2549
US

IV. Provider business mailing address

2091 NOSTRAND AVE
BROOKLYN NY
11210-2549
US

V. Phone/Fax

Practice location:
  • Phone: 718-434-1876
  • Fax: 347-663-4299
Mailing address:
  • Phone: 718-434-1876
  • Fax: 347-663-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number250074
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: