Healthcare Provider Details

I. General information

NPI: 1477527935
Provider Name (Legal Business Name): PASQUALE MICHAEL DESANTO D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8404 13TH AVE
BROOKLYN NY
11228-3302
US

IV. Provider business mailing address

8404 13TH AVE
BROOKLYN NY
11228-3302
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-6220
  • Fax: 718-745-6229
Mailing address:
  • Phone: 718-745-6220
  • Fax: 718-745-6229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberN006056-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: