| Doctor Name: | DR. MARK DESANTIS |
| NPI Number: | 1053424192 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 25MB08021500 |
| Business Practice Address: | 79 Middleville Rd Northport, NY - 11768 |
| Business Phone Number: | 6312614400 |
| Business Fax Number: | |
| Mailing Address: | 79 Middleville Rd, NORTHPORT |
| State: | NY |
| Postal Code: | 117682200 |
| Phone Number: | 6312614400 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 11/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | 25MB08021500 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |