Provider Demographics
NPI:1568462752
Name:SANTOS, FERDINAND G (PT)
Entity Type:Individual
Prefix:
First Name:FERDINAND
Middle Name:G
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 GREENBROOK RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07060-4560
Mailing Address - Country:US
Mailing Address - Phone:908-755-2128
Mailing Address - Fax:908-755-0614
Practice Address - Street 1:50 GREENBROOK RD
Practice Address - Street 2:
Practice Address - City:NORTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-4560
Practice Address - Country:US
Practice Address - Phone:908-755-2128
Practice Address - Fax:908-755-0614
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01315700174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ031225Medicare UPIN