Provider Demographics
NPI:1407923618
Name:SANTARELLI, NICOLA (DPM)
Entity Type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:SANTARELLI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 WHITE PLAINS RD
Mailing Address - Street 2:STE 18
Mailing Address - City:EASTCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10709-5537
Mailing Address - Country:US
Mailing Address - Phone:914-337-4325
Mailing Address - Fax:914-395-1860
Practice Address - Street 1:475 WHITE PLAINS RD
Practice Address - Street 2:STE 18
Practice Address - City:EASTCHESTER
Practice Address - State:NY
Practice Address - Zip Code:10709-5537
Practice Address - Country:US
Practice Address - Phone:914-337-4325
Practice Address - Fax:914-395-1860
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0047951213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01373211Medicaid
P55361Medicare PIN
NY01373211Medicaid