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: 01/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 55TH ST
BROOKLYN NY
11220-3263
US

IV. Provider business mailing address

8800 20TH AVE APT 6L
BROOKLYN NY
11214-4821
US

V. Phone/Fax

Practice location:
  • Phone: 718-686-1733
  • 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 Code225400000X
TaxonomyRehabilitation Practitioner
License Number202437
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: