Provider Demographics
NPI:1730347964
Name:SANTIAGO, JOSEPHINE M (CRNA)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:M
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:OMANA
Other - Last Name:SANTIAGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:68 S. SERVICE RD.
Mailing Address - Street 2:STE 350
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-2358
Mailing Address - Country:US
Mailing Address - Phone:516-945-3347
Mailing Address - Fax:516-945-3131
Practice Address - Street 1:310 WOODSTOWN RD.
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NJ
Practice Address - Zip Code:08079
Practice Address - Country:US
Practice Address - Phone:856-935-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR09422300163W00000X
NJ26NJ00202600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00678802OtherRAILROAD MEDICARE PTAN
079224OtherAANA ID#
079224OtherAANA ID#