Provider Demographics
NPI:1558636431
Name:JOSEPH P. SANTIAMO MEDICINE P.C.
Entity Type:Organization
Organization Name:JOSEPH P. SANTIAMO MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:SANTIAMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-967-3000
Mailing Address - Street 1:4268 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6239
Mailing Address - Country:US
Mailing Address - Phone:718-967-3000
Mailing Address - Fax:718-966-2083
Practice Address - Street 1:4268 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6239
Practice Address - Country:US
Practice Address - Phone:718-967-3000
Practice Address - Fax:718-966-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY157471204R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204R00000XAllopathic & Osteopathic PhysiciansElectrodiagnostic MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01062064Medicaid
NYA63669Medicare UPIN