Healthcare Provider Details

I. General information

NPI: 1831508654
Provider Name (Legal Business Name): MARCO RUIZ SANTILLAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E 59TH ST FL 8
NEW YORK NY
10022-1304
US

IV. Provider business mailing address

110 E 59TH ST RM 8B
NEW YORK NY
10022-1359
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-3934
  • Fax: 212-434-4974
Mailing address:
  • Phone: 212-434-3994
  • Fax: 212-434-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number289988
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: