Provider Demographics
NPI:1396933834
Name:RONALD P. SANTASIERO MD PC
Entity type:Organization
Organization Name:RONALD P. SANTASIERO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTASIERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:716-646-6075
Mailing Address - Street 1:4535 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 801
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-1860
Mailing Address - Country:US
Mailing Address - Phone:716-646-6075
Mailing Address - Fax:716-646-5912
Practice Address - Street 1:4535 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 801
Practice Address - City:HAMBURG
Practice Address - State:NY
Practice Address - Zip Code:14075-1860
Practice Address - Country:US
Practice Address - Phone:716-646-6075
Practice Address - Fax:716-646-5912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127739174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010157102OtherUNIVERA HEALTHCARE
NYBA0627Medicare PIN