Provider Demographics
NPI:1427243328
Name:HORTA-SANTINI, JUAN M (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:M
Last Name:HORTA-SANTINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:M
Other - Last Name:HORTA-SANTINI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:100-05 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:917-832-7557
Mailing Address - Fax:917-832-7503
Practice Address - Street 1:10005 ROOSEVELT AVE STE 202
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4880
Practice Address - Country:US
Practice Address - Phone:917-832-7557
Practice Address - Fax:917-832-7503
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266984207W00000X
PR17507261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300546743Medicaid
NYG400743584Medicaid
NY03524292Medicaid
NY266984OtherLICENSE