Provider Demographics
NPI:1578528816
Name:SANTIAGO, MARIA T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA T
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 MARCUS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2058
Mailing Address - Country:US
Mailing Address - Phone:516-321-8680
Mailing Address - Fax:516-321-8685
Practice Address - Street 1:1991 MARCUS AVE STE 302
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2058
Practice Address - Country:US
Practice Address - Phone:516-321-8680
Practice Address - Fax:516-321-8685
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1494682080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02313239Medicaid
NY02313239Medicaid
E78972Medicare UPIN
NY56861Medicare ID - Type Unspecified