1659332377 NPI number — MARISSA T. SANTOS M.D.

Table of content: JESSICA AMANDA PENNELL (NPI 1265943294)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659332377 NPI number — MARISSA T. SANTOS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTOS
Provider First Name:
MARISSA
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659332377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6914 41ST AVE
Provider Second Line Business Mailing Address:
SUITE C2
Provider Business Mailing Address City Name:
WOODSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11377-4028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-478-5600
Provider Business Mailing Address Fax Number:
718-478-5335

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9229 QUEENS BLVD
Provider Second Line Business Practice Location Address:
SUITE CB
Provider Business Practice Location Address City Name:
REGO PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11374-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-478-5600
Provider Business Practice Location Address Fax Number:
718-478-5335
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  198043 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0403354 . This is a "UNITED HEALTHCARE HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1531786 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 470858484 . This is a "1199NATIONAL BENEFIT FUND" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01833536 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2592255 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113380648SA01 . This is a "CARE PLUS HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198043 . This is a "HIP HEALTH PLAN OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 198043B27 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 41124 . This is a "CORPORATE BEN SVC AMERICA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0166AF1 . This is a "EMPIRE BCBS WOODSIDE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040426017706 . This is a "FIDELIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1P1113 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5816203 . This is a "AETNA USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 8433171 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: SM8043 . This is a "AFFINITY HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 172917 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 11P8501 . This is a "NY PRESBYTERIAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P384086 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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