Individual
MR. KEVIN SANTOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
30 PROSPECT AVE, HACKENSACK, NJ 07601-1915
(551) 996-2419
Mailing address
515 W 36TH ST APT 32B, NEW YORK, NY 10018-0705
(908) 217-5234
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA10871200
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11728700
NJCDS
NJ
Enumeration date
03/25/2016
Last updated
06/25/2021
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