Healthcare Provider Details

I. General information

NPI: 1578528816
Provider Name (Legal Business Name): MARIA T SANTIAGO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1991 MARCUS AVE STE 302
NEW HYDE PARK NY
11042-2058
US

IV. Provider business mailing address

1991 MARCUS AVE STE 302
NEW HYDE PARK NY
11042-2058
US

V. Phone/Fax

Practice location:
  • Phone: 516-321-8680
  • Fax: 516-321-8685
Mailing address:
  • Phone: 516-321-8680
  • Fax: 516-321-8685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number149468
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: