Healthcare Provider Details

I. General information

NPI: 1659326841
Provider Name (Legal Business Name): LUCIA J SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST THE METHODIST HOSPITAL
BROOKLYN NY
11215
US

IV. Provider business mailing address

PO BOX 681 VAN BURNT STATION
BROOKLYN NY
11215
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3159
  • Fax: 610-617-6280
Mailing address:
  • Phone: 800-666-2455
  • Fax: 610-617-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number194231
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: