Provider Demographics
NPI:1720162811
Name:SANTIAGO, RICARDO N (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:N
Last Name:SANTIAGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 20TH AVE APT 6L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4821
Mailing Address - Country:US
Mailing Address - Phone:646-643-4267
Mailing Address - Fax:347-492-5526
Practice Address - Street 1:824 55TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3263
Practice Address - Country:US
Practice Address - Phone:718-686-1733
Practice Address - Fax:718-686-1723
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202437225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01846395Medicaid
NYRS096E0210OtherBLUE CROSS BLUE SHIELD
NY202437OtherHIP
NYP2099873OtherOXFORD
NY2799800OtherGHI
NY164456OtherELDERPLAN
NYG100036646Medicare PIN
NYA100033529Medicare PIN
NY202437OtherHIP
NY164456OtherELDERPLAN