Provider Demographics
NPI:1659966919
Name:SANTOS, JEFFREY SIMOES
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SIMOES
Last Name:SANTOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STEMLER DR
Mailing Address - Street 2:
Mailing Address - City:CLIFFWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07721-1508
Mailing Address - Country:US
Mailing Address - Phone:732-558-3256
Mailing Address - Fax:
Practice Address - Street 1:20 CHERRY TREE FARM RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2251
Practice Address - Country:US
Practice Address - Phone:732-402-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00780000111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner