MEDICARE: RICARDO N SANTIAGO MD PC

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	208100000X	Physical Medicine & Rehabilitation Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508176579
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICARDO N SANTIAGO MD PC

Provider Business Mailing Address
First Line	:	6252 AUSTIN ST
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-1560
Country	:	US
Telephone Number	:	646-643-4267
Fax Number	:

Provider Business Practice Location Address
First Line	:	5434 2ND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2606
Country	:	US
Telephone Number	:	718-360-2228
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RICARDO N SANTIAGO
Credential	:	MD
Telephone Number	:	646-643-4267

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	11/05/2010

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