Provider Demographics
NPI:1649491127
Name:PHYSICIAN WHO MAKES HOUSE CALLS
Entity type:Organization
Organization Name:PHYSICIAN WHO MAKES HOUSE CALLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTIAGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-896-7712
Mailing Address - Street 1:124 SMITHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-2452
Mailing Address - Country:US
Mailing Address - Phone:845-896-7712
Mailing Address - Fax:
Practice Address - Street 1:124 SMITHTOWN RD
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2452
Practice Address - Country:US
Practice Address - Phone:845-896-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01366898Medicaid
NY01366898Medicaid
NY78K861Medicare ID - Type Unspecified