Provider Demographics
NPI:1841050812
Name:SANTARELLI, JOHN LUIS JR
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LUIS
Last Name:SANTARELLI
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 COUNTRY CLUB RD APT 104
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3747
Mailing Address - Country:US
Mailing Address - Phone:845-518-2332
Mailing Address - Fax:
Practice Address - Street 1:425 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1775
Practice Address - Country:US
Practice Address - Phone:607-724-1391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY902131163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse