Provider Demographics
NPI:1720630676
Name:BELLINGER, JUSTIN SANTANA
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SANTANA
Last Name:BELLINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 ARCH ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-7327
Mailing Address - Country:US
Mailing Address - Phone:215-948-8159
Mailing Address - Fax:
Practice Address - Street 1:2929 ARCH ST STE 1700
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-7327
Practice Address - Country:US
Practice Address - Phone:215-948-8159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health