Provider Demographics
NPI:1497875975
Name:SANTOS, ANTHONY JOSEPH RECIO (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY JOSEPH
Middle Name:RECIO
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:972 BRUSH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1740
Mailing Address - Country:US
Mailing Address - Phone:516-876-5555
Mailing Address - Fax:516-876-1246
Practice Address - Street 1:430 LAKEVILLE RD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1121
Practice Address - Country:US
Practice Address - Phone:718-470-8957
Practice Address - Fax:718-413-1913
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ67394Medicare UPIN