Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 38MC00181500 | NJ |
NPI | 1134106669 |
---|---|
Provider Name | Dr. Philip T Santiago |
First Address | Boonton, NJ 07005-9442 |
Second Address | Lake Hiawatha, NJ 07034-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T44887 | (02) |