Provider Demographics
NPI:1265897581
Name:SANTIAGO, ERIK (CNIM)
Entity type:Individual
Prefix:
First Name:ERIK
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 FRONT ST
Mailing Address - Street 2:STE 280
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2800
Mailing Address - Country:US
Mailing Address - Phone:484-351-8459
Mailing Address - Fax:206-350-9656
Practice Address - Street 1:1086 TEANECK RD
Practice Address - Street 2:STE 4A
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-4854
Practice Address - Country:US
Practice Address - Phone:484-351-8459
Practice Address - Fax:206-350-9656
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic