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General NPI Number Information
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NPI Number | 1427140805
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Entity Type | Individual
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Provider Name | EDUARDO SANTIAGO ANTONIO JR. PA
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1879 MADISON AVE
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City | NEW YORK
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State | NY
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Zip | 10035-2709
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Country | US
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Telephone | 212-423-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 80 CHARLOTTE PL
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City | HARTSDALE
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State | NY
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Zip | 10530-2602
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Country | US
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Telephone | 914-625-4568
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 0004771
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License Number State | NY
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