Individual
DR. MARYANNE DESANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
375 SEGUINE AVE, STATEN ISLAND, NY 10309-3932
(718) 226-2440
Mailing address
1 EDGEWATER ST, 6TH FL. PAYER RELATION, STATEN ISLAND, NY 10305-4900
(718) 226-1008
(718) 226-1039
Taxonomy
Speciality
Code
Description
License number
State
2084F0202X
Forensic Psychiatry Physician
190585
NY
2084P0800X
Psychiatry Physician
Primary
190585
NY
2084P0802X
Addiction Psychiatry Physician
190585
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02106196
—
NY
01
—
260049316
RAILROAD MEDICARE
—
01
—
DN0541
RAILROAD MEDICARE GRP #
NY
01
—
P00602172
RAILROAD MEDICARE
NY
Enumeration date
11/30/2005
Last updated
08/01/2008
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