MEDICARE: KATHY SANTIAGO MS

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1760735633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY SANTIAGO MS

Provider Business Mailing Address
First Line	:	900 FLUSHING AVE
Second Line	:	# 2 L
City	:	BROOKLYN
State	:	NY
Zip	:	11206
Country	:	US
Telephone Number	:	917-972-1999
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 AUSTIN STREET AVENUE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	186-669-6099
Fax Number	:

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

Provider Enumeration Date	:	10/17/2012
Last Update Date	:	10/17/2012

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