Provider Demographics
NPI:1821229469
Name:SANTACROCE, GLEN JOSEPH (OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:GLEN
Middle Name:JOSEPH
Last Name:SANTACROCE
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:115 MAIN ST
Mailing Address - Street 2:SUITE 202 2ND FLOOR
Mailing Address - City:TUCKAHOE
Mailing Address - State:NY
Mailing Address - Zip Code:10707-2948
Mailing Address - Country:US
Mailing Address - Phone:914-961-1010
Mailing Address - Fax:914-961-1011
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:SUITE 202 2ND FLOOR
Practice Address - City:TUCKAHOE
Practice Address - State:NY
Practice Address - Zip Code:10707-2948
Practice Address - Country:US
Practice Address - Phone:914-961-1010
Practice Address - Fax:914-961-1011
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-30
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009374-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0401995OtherCIGNA-ORTHONET
NY201116700038OtherAFFINITY HEALTH PLAN
NY401995OtherAETNA-ORTHONET
NYP4162451OtherOXFORD FREEDOM/LIBERTY NETWORK OPTUM HEALTHCARE SOLUTIONS, INC.
NY123832POtherHIP-EMBLEM HEALTH
NY9830612OtherAETNA LOCAL 1199
NY03164830Medicaid
NY401995OtherUS FAMILY HEALTH-ORTHONET
NYP01164884OtherMVP HEALTH PLAN
NY000000695401OtherEMBLEM HEALTH/GHI HMO
NY0000299267411OtherUNITED HEALTHCARE- OPTUM HEALTHCARE SOLUTIONS, INC.
NY1729949OtherEMBLEM HEALTH-GHI PPO
NY03282455Medicaid
61630500OtherFECA/OFFICE OF WORKERS COMPENSATION PROGRAM
NYQV7681OtherEMPIRE BLUE CROSS
NYP4162451OtherOXFORD FREEDOM/LIBERTY NETWORK OPTUM HEALTHCARE SOLUTIONS, INC.