Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC007234 | PA |
NPI | 1073272571 |
---|---|
Provider Name | Alexa Ray Santomero |
First Address | Medford, NJ 08055-2713 |
Second Address | Glenside, PA 19038-5009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2021 |
Last Update Date | 12/12/2021 |