Healthcare Provider Details

I. General information

NPI: 1013546068
Provider Name (Legal Business Name): GABRIELA SANTIAGO-ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GABRIELA SANTIAGO PICHARDO

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E 102ND ST
NEW YORK NY
10029-5204
US

IV. Provider business mailing address

17 E 102ND ST
NEW YORK NY
10029-5204
US

V. Phone/Fax

Practice location:
  • Phone: 212-659-8551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number314024
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: