Provider Demographics
NPI:1700445103
Name:SANTOS, RONNIE (PTA, AOEAS)
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:
Last Name:SANTOS
Suffix:
Gender:M
Credentials:PTA, AOEAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3800
Mailing Address - Country:US
Mailing Address - Phone:201-921-0530
Mailing Address - Fax:
Practice Address - Street 1:100 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3800
Practice Address - Country:US
Practice Address - Phone:201-921-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB001834225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant