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NPI Code Detail

MEDICARE: TETYANA PENSABENE

MEDICARE: TETYANA PENSABENE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant031426NY

General Provider Information

NPI Number : 1083480784
Entity Type Code : Individual
Provider Name (Legal Business Name) : TETYANA PENSABENE
Provider Business Mailing Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 475 SEAVIEW AVE
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10305-3436
Country : US
Telephone Number : 718-226-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2023
Last Update Date : 05/18/2026

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Directions to “ TETYANA PENSABENE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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