Provider Demographics
NPI:1598791998
Name:SANTOS, NEIL MICHAEL (PT)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:MICHAEL
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 1:1 DEGRAW AVE
Mailing Address - Street 2:NJOS
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-692-9699
Mailing Address - Fax:201-530-0085
Practice Address - Street 1:1 DEGRAW AVE
Practice Address - Street 2:NORTH JERSEY ORTHOPEDIC SPECIALISTS
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-692-9699
Practice Address - Fax:201-530-0085
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA010725002251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
085198BMPMedicare ID - Type Unspecified