Healthcare Provider Details

I. General information

NPI: 1821404351
Provider Name (Legal Business Name): JONOR ESPIRITU SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

METRO COMMUNITY HEALTH CENTER 2324 FOREST AVENUE
STATEN ISLAND NY
10303-1506
US

IV. Provider business mailing address

52 GRACE DR
OLD BRIDGE NJ
08857-2546
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-0200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401524
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: