1154175479 NPI number — MR. HERSON SANTIAGO FLORES SANGA M.D.

Table of content: MR. HERSON SANTIAGO FLORES SANGA M.D. (NPI 1154175479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154175479 NPI number — MR. HERSON SANTIAGO FLORES SANGA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLORES SANGA
Provider First Name:
HERSON
Provider Middle Name:
SANTIAGO
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154175479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 FIRST AVENUE AT 97TH STREET
Provider Second Line Business Mailing Address:
NYC H H/ METROPOLITAN HOSPITAL, DEPARTMENT OF MEDICINE
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-423-6771
Provider Business Mailing Address Fax Number:
212-423-8099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 FIRST AVENUE AT 97TH STREET
Provider Second Line Business Practice Location Address:
NYC H H/ METROPOLITAN HOSPITAL, DEPARTMENT OF MEDICINE
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-423-6771
Provider Business Practice Location Address Fax Number:
212-423-8099
Provider Enumeration Date:
04/15/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)