Provider Demographics
NPI:1437210887
Name:SANTIAGO, EMAUS BRENDAN (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:EMAUS
Middle Name:BRENDAN
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76-55 AUSTIN STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-897-2228
Mailing Address - Fax:718-897-2251
Practice Address - Street 1:76-55 AUSTIN STREET
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-897-2228
Practice Address - Fax:718-897-2251
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103810363A00000X
NY009826207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9103810OtherSTATE LICENSE