Provider Demographics
NPI:1932407608
Name:RICHARD P. SANTAROSA , LLC
Entity type:Organization
Organization Name:RICHARD P. SANTAROSA , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTAROSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-356-9391
Mailing Address - Street 1:166 W BROAD ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3661
Mailing Address - Country:US
Mailing Address - Phone:203-356-9391
Mailing Address - Fax:203-356-0270
Practice Address - Street 1:166 W BROAD ST
Practice Address - Street 2:SUITE 404
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3661
Practice Address - Country:US
Practice Address - Phone:203-356-9391
Practice Address - Fax:203-356-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0351012088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000288Medicare PIN