Healthcare Provider Details

I. General information

NPI: 1558636431
Provider Name (Legal Business Name): JOSEPH P. SANTIAMO MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2012
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4268 RICHMOND AVE
STATEN ISLAND NY
10312-6239
US

IV. Provider business mailing address

4268 RICHMOND AVE
STATEN ISLAND NY
10312-6239
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-3000
  • Fax: 718-966-2083
Mailing address:
  • Phone: 718-967-3000
  • Fax: 718-966-2083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number157471
License Number StateNY

VIII. Authorized Official

Name: DR. JOSEPH PATRICK SANTIAMO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-967-3000