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General NPI Number Information
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NPI Number | 1649491127
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Entity Type | Organization
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Legal Business Name | PHYSICIAN WHO MAKES HOUSE CALLS
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 124 SMITHTOWN RD
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City | FISHKILL
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State | NY
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Zip | 12524-2452
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Country | US
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Telephone | 845-896-7712
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Fax |
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Provider Business Mailing Address
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Address Line | 124 SMITHTOWN RD
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City | FISHKILL
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State | NY
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Zip | 12524-2452
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Country | US
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Telephone | 845-896-7712
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JEANINE SANTIAGO
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Credential | M.D.
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Telephone | 845-896-7712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 181053
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License Number State | NY
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