Provider Demographics
NPI:1457852840
Name:TITAN HEALTH TEAM, INC.
Entity Type:Organization
Organization Name:TITAN HEALTH TEAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SANTUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-224-4157
Mailing Address - Street 1:4 WESTGATE LN APT C
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-6358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 WESTGATE LN APT C
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-6358
Practice Address - Country:US
Practice Address - Phone:516-224-4157
Practice Address - Fax:516-864-4599
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TITAN HEALTH TEAM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225164261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02365837Medicaid