Provider Demographics
NPI:1992102321
Name:SANTANA, ALEXIA
Entity type:Individual
Prefix:
First Name:ALEXIA
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 CASTLETON AVE
Mailing Address - Street 2:BOOKKEEPING DEPARTMENT
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-2709
Mailing Address - Country:US
Mailing Address - Phone:718-447-7800
Mailing Address - Fax:718-448-7200
Practice Address - Street 1:275 CASTLETON AVE
Practice Address - Street 2:BOOKKEEPING DEPARTMENT
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-2709
Practice Address - Country:US
Practice Address - Phone:718-447-7800
Practice Address - Fax:718-448-7200
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00308732Medicaid
NY00308732Medicaid