Provider Demographics
NPI:1649353905
Name:MESSINA-SANTIAGO, RENEE (DO)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:MESSINA-SANTIAGO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:MESSINA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:31 MERRICK AVE
Mailing Address - Street 2:SUITE 10
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3477
Mailing Address - Country:US
Mailing Address - Phone:516-771-9797
Mailing Address - Fax:516-771-9798
Practice Address - Street 1:31 MERRICK AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3477
Practice Address - Country:US
Practice Address - Phone:516-771-9797
Practice Address - Fax:516-771-9798
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2385071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine