Provider Demographics
NPI:1497796973
Name:SANTIAGO, EDDIE W (MD)
Entity Type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:W
Last Name:SANTIAGO
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 1:100 HIGHWAY 36 STE 2M
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1453
Mailing Address - Country:US
Mailing Address - Phone:732-531-6600
Mailing Address - Fax:732-531-6606
Practice Address - Street 1:100 HIGHWAY 36 STE 2M
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1453
Practice Address - Country:US
Practice Address - Phone:732-531-6600
Practice Address - Fax:732-531-6606
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA7319500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH54449Medicare UPIN
NJ054404Medicare ID - Type Unspecified