Healthcare Provider Details

I. General information

NPI: 1720162811
Provider Name (Legal Business Name): RICARDO N SANTIAGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/02/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1957 CONEY ISLAND AVE.
BROOKLYN NY
11223
US

IV. Provider business mailing address

7917 18 AVE. 2ND FLOOR
BROOKLYN NY
11214-1703
US

V. Phone/Fax

Practice location:
  • Phone: 347-407-4073
  • Fax: 718-686-1723
Mailing address:
  • Phone: 646-643-4267
  • Fax: 347-492-5526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number202437
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number202437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: