Provider Demographics
NPI:1306671631
Name:SANTOS, ROSEANNE MAE MARQUEZ
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:MAE MARQUEZ
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 70TH STREET
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377
Mailing Address - Country:US
Mailing Address - Phone:347-829-3890
Mailing Address - Fax:347-829-3888
Practice Address - Street 1:4131 70TH STREET
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:347-829-3890
Practice Address - Fax:347-829-3888
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2025-07-28
Deactivation Date:2025-06-13
Deactivation Code:
Reactivation Date:2025-07-28
Provider Licenses
StateLicense IDTaxonomies
NY052249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist