MEDICARE: DR. JOHN J SANTUCCI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	176343	NY

General Provider Information

NPI Number	:	1194728063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN J SANTUCCI M.D.

Provider Business Mailing Address
First Line	:	1999 MARCUS AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1999 MARCUS AVE
Second Line	:	SUITE 110
City	:	LAKE SUCCESS
State	:	NY
Zip	:	11042-1017
Country	:	US
Telephone Number	:	516-355-5525
Fax Number	:	516-355-5531

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	03/26/2021

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