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General NPI Number Information
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NPI Number | 1659966919
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Entity Type | Individual
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Provider Name | JEFFREY SIMOES SANTOS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2021
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Last Update Date | 03/08/2021
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Provider Practice Location Address
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Address Line | 20 CHERRY TREE FARM RD
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City | MIDDLETOWN
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State | NJ
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Zip | 07748-2251
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Country | US
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Telephone | 732-402-7882
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Fax |
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Provider Business Mailing Address
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Address Line | 22 STEMLER DR
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City | CLIFFWOOD
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State | NJ
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Zip | 07721-1508
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Country | US
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Telephone | 732-558-3256
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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 | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | 38MC00780000
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License Number State | NJ
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