Basic Information
| Provider Information | |||||||||
| NPI: | 1770593998 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANTINA | ||||||||
| FirstName: | JORDAN | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BEECH DR | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 BEECH DR | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 10/10/2007 | ||||||||
| NPIReactivationDate: | 01/08/2008 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | OS008992L | PA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 260001000 | 01 | PA | MAGELLAN BEHAVIORAL HEALT | OTHER | P00291313 | 01 | PA | RAILROAD MEDICARE | OTHER | 663726 | 01 | PA | BLUSHIELD | OTHER |