Healthcare Provider Details

I. General information

NPI: 1497603948
Provider Name (Legal Business Name): JENNA SANTORO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 GRANDVIEW RD
CENTRAL VALLEY NY
10917-3723
US

IV. Provider business mailing address

23 GRANDVIEW RD
CENTRAL VALLEY NY
10917-3723
US

V. Phone/Fax

Practice location:
  • Phone: 845-238-1104
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number030976-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: