Basic Information
| Provider Information | |||||||||
| NPI: | 1851512362 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTILLI | ||||||||
| FirstName: | TIRZA | ||||||||
| MiddleName: | SUZANNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 MILL RIVER ROAD | ||||||||
| Address2: | |||||||||
| City: | CHAPPAQUA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9142388585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 487 S BROADWAY # 220 | ||||||||
| Address2: | C/O WJCS | ||||||||
| City: | YONKERS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 107053269 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144234433 | ||||||||
| FaxNumber: | 9144239434 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 04/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | F400797 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 00245294 | 05 | NY | MEDICAID |