Provider Demographics
NPI:1497750848
Name:SANTANA, JOSE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:
Last Name:SANTANA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2566
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093-0641
Mailing Address - Country:US
Mailing Address - Phone:201-854-0055
Mailing Address - Fax:201-854-2633
Practice Address - Street 1:425 70TH ST
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-2417
Practice Address - Country:US
Practice Address - Phone:201-854-0055
Practice Address - Fax:201-854-2633
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05225300207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5581907Medicaid
NJ4404508OtherAETNA PPO ID #
NJ5581702Medicaid
NJ061342OtherEMPIRE BC/BS SECAUCUS #
NJ19891OtherUNIVERSITY HEALTH PLANS
NJ061343OtherEMPIRE BC/BS NEWARK #
NJ1050360OtherHORIZON NJ HEALTH #
NJ06I341OtherEMPIRE BC/BS GUTTENBERG #
NJ2198746OtherGHI ID #
NJP670145OtherOXFORD ID #
NJ475742OtherAETNA HMO ID #
NJ010000150-03OtherAMERICHOICE ID #
NY01762207Medicaid
NJ0298711000OtherAMERIHEALTH ID #
NJ2K0240OtherHEALTHNET ID #
NJP670145OtherOXFORD ID #
NJ0298711000OtherAMERIHEALTH ID #