Provider Demographics
NPI:1477527935
Name:DESANTO, PASQUALE MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:PASQUALE
Middle Name:MICHAEL
Last Name:DESANTO
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 1:8404 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3302
Mailing Address - Country:US
Mailing Address - Phone:718-745-6220
Mailing Address - Fax:718-745-6229
Practice Address - Street 1:8404 13TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3302
Practice Address - Country:US
Practice Address - Phone:718-745-6220
Practice Address - Fax:718-745-6229
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006056-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV08062Medicare UPIN