Provider Demographics
NPI:1952494346
Name:DESANTO, CARMINE A (DC)
Entity Type:Individual
Prefix:DR
First Name:CARMINE
Middle Name:A
Last Name:DESANTO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8324 FOURTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-680-8595
Mailing Address - Fax:718-680-8513
Practice Address - Street 1:8324 FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-680-8595
Practice Address - Fax:718-680-8513
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00610100111N00000X
NYX0092991111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X3C551Medicare ID - Type Unspecified
U79036Medicare UPIN