Basic Information
| Provider Information | |||||||||
| NPI: | 1699441550 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTANA-NUNEZ | ||||||||
| FirstName: | ELIDOMI | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 RIVER RD APT 305 | ||||||||
| Address2: | |||||||||
| City: | EDGEWATER | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070201393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019131110 | ||||||||
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| Practice Location | |||||||||
| Address1: | 663 PALISADE AVE | ||||||||
| Address2: | |||||||||
| City: | CLIFFSIDE PARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070103012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019456500 | ||||||||
| FaxNumber: | 2019451157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2021 | ||||||||
| LastUpdateDate: | 08/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 25MP00641000 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.