1275600595 NPI number — DR. MANUAL SANTIAGO-PATTERSON DMD

Table of content: DR. MANUAL SANTIAGO-PATTERSON DMD (NPI 1275600595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275600595 NPI number — DR. MANUAL SANTIAGO-PATTERSON DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTIAGO-PATTERSON
Provider First Name:
MANUAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
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:
1275600595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SARATOGA VILLAGE BLVD
Provider Second Line Business Mailing Address:
SUITE 36A
Provider Business Mailing Address City Name:
BALLSTON SPA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12020-3737
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-899-9783
Provider Business Mailing Address Fax Number:
518-899-4007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
489 BERNARDSTON RD
Provider Second Line Business Practice Location Address:
CHERRY RUM PLAZA
Provider Business Practice Location Address City Name:
GREENFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01301-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-773-3850
Provider Business Practice Location Address Fax Number:
413-773-5300
Provider Enumeration Date:
11/30/2006

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: 1223G0001X , with the licence number:  20924 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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