Provider Demographics
NPI:1730310897
Name:SANTOS, LETTY (PT)
Entity Type:Individual
Prefix:MRS
First Name:LETTY
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MONTGOMERY ST
Mailing Address - Street 2:SUITE 603
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302
Mailing Address - Country:US
Mailing Address - Phone:201-433-1955
Mailing Address - Fax:201-433-1655
Practice Address - Street 1:75 MONTGOMERY STREET
Practice Address - Street 2:SUITE 603
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302
Practice Address - Country:US
Practice Address - Phone:201-433-1955
Practice Address - Fax:201-433-1655
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01050200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist