Provider Demographics
NPI:1932288453
Name:ELISSA J SANTORO MD PA
Entity Type:Organization
Organization Name:ELISSA J SANTORO MD PA
Other - Org Name:BREAST CARE & TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELISSA
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SANTORO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-533-0222
Mailing Address - Street 1:200 SOUTH ORANGE AVENUE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-533-0222
Mailing Address - Fax:973-535-1121
Practice Address - Street 1:200 SOUTH ORANGE AVENUE
Practice Address - Street 2:SUITE 112
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-533-0222
Practice Address - Fax:973-535-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA022357002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1427014182OtherNPI CMS
1528023405OtherNPI CMS
1427014182OtherNPI CMS