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General NPI Number Information
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NPI Number | 1073484572
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Entity Type | Individual
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Provider Name | ROD ANTHONY SANTIAGO
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Gender | Male
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 475 NORTHERN BLVD STE 11
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City | GREAT NECK
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State | NY
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Zip | 11021-4802
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Country | US
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Telephone | 516-829-0300
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Fax | 516-466-7723
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Provider Business Mailing Address
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Address Line | 431 E BROADWAY APT 2A
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City | LONG BEACH
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State | NY
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Zip | 11561-4463
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 054693
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License Number State | NY
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