Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 217808 | NY |
NPI | 1003003856 |
---|---|
Provider Name | Dr. Cynthia Santiago |
First Address | Port Jefferson Station, NY 11776-2568 |
Second Address | Port Jefferson Station, NY 11776-3336 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2007 |
Last Update Date | 19/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02162494 | (05) | NY |
H37637 | (02) | NY |