Healthcare Provider Details

I. General information

NPI: 1427706662
Provider Name (Legal Business Name): JAMES URBANO MANALASTAS SANTOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HEROES WAY
RIVERHEAD NY
11901-2058
US

IV. Provider business mailing address

1 HEROES WAY
RIVERHEAD NY
11901-2054
US

V. Phone/Fax

Practice location:
  • Phone: 631-548-6000
  • Fax:
Mailing address:
  • Phone: 631-548-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number340297
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: