Individual
JONATHAN MICHAEL DESANTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2 PALISADES DR, ALBANY, NY 12205-1438
(518) 458-2000
(518) 458-1524
Mailing address
PO BOX 14890, ALBANY, NY 12212-4890
(518) 525-5634
(518) 649-4094
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
139136
NY
207RI0011X
Interventional Cardiology Physician
139136
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00767079
—
NY
05
—
1003579
—
VT
Enumeration date
07/10/2005
Last updated
05/11/2021
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