Basic Information
| Provider Information | |||||||||
| NPI: | 1821404351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESPIRITU-SANTIAGO | ||||||||
| FirstName: | JONOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 GRACE DR | ||||||||
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| City: | OLD BRIDGE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088572546 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | METRO COMMUNITY HEALTH CENTER | ||||||||
| Address2: | 2324 FOREST AVENUE | ||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103031506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184470200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2014 | ||||||||
| LastUpdateDate: | 03/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 401524 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.