Provider Demographics
NPI:1699835231
Name:SANTOS, SHERWIN DE LA ROSA (PT)
Entity Type:Individual
Prefix:MR
First Name:SHERWIN
Middle Name:DE LA ROSA
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 1:22 CARNATION ST
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-3802
Mailing Address - Country:US
Mailing Address - Phone:201-661-0911
Mailing Address - Fax:
Practice Address - Street 1:22 CARNATION ST
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-3802
Practice Address - Country:US
Practice Address - Phone:201-661-0911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQAO7859171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor