1265121610 NPI number — MARCOS GUIERMO ROSA SANTANA MD

Table of content: MARCOS GUIERMO ROSA SANTANA MD (NPI 1265121610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265121610 NPI number — MARCOS GUIERMO ROSA SANTANA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSA SANTANA
Provider First Name:
MARCOS
Provider Middle Name:
GUIERMO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1265121610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/07/2023
NPI Reactivation Date:
12/07/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1650 GRAND CONCOURSE
Provider Second Line Business Mailing Address:
BRONXCARE DEPARTMENT OF SURGERY
Provider Business Mailing Address City Name:
BRONX
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-960-1276
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
BRONXCARE DEPARTMENT OF SURGERY
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-960-1276
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com