Provider Demographics
NPI:1669813770
Name:SANTORO, KATELYN ELLEN (PA-C)
Entity type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ELLEN
Last Name:SANTORO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2177 OAK TREE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1090
Mailing Address - Country:US
Mailing Address - Phone:908-754-2100
Mailing Address - Fax:
Practice Address - Street 1:2177 OAK TREE RD STE 210
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1090
Practice Address - Country:US
Practice Address - Phone:908-754-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00311900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant