Provider Demographics
NPI:1053448506
Name:SANTO, TIMOTHY R (DC)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:R
Last Name:SANTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 OAK ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3875
Mailing Address - Country:US
Mailing Address - Phone:201-444-1215
Mailing Address - Fax:
Practice Address - Street 1:38 OAK ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3875
Practice Address - Country:US
Practice Address - Phone:201-444-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 00280500111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062346Medicare PIN