Healthcare Provider Details

I. General information

NPI: 1750441002
Provider Name (Legal Business Name): MICHAEL PATRICK SANTORO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2006
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 BLOOMINGDALE RD
STATEN ISLAND NY
10309-2061
US

IV. Provider business mailing address

520 BLOOMINGDALE RD
STATEN ISLAND NY
10309-2061
US

V. Phone/Fax

Practice location:
  • Phone: 718-370-9100
  • Fax: 718-370-9199
Mailing address:
  • Phone: 718-370-9100
  • Fax: 718-370-9199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number203842
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: