Healthcare Provider Details

I. General information

NPI: 1093552390
Provider Name (Legal Business Name): CYNTIA F ANDRADE SANTAMARIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10721 QUEENS BLVD STE 9
FOREST HILLS NY
11375-4451
US

IV. Provider business mailing address

119 DEMOTT AVE
CLIFTON NJ
07011-3309
US

V. Phone/Fax

Practice location:
  • Phone: 718-285-7585
  • Fax: 212-202-4884
Mailing address:
  • Phone: 201-233-1273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: