MEDICARE: STEVEN TEMPLETON PHYSICIAN ASSISTANT

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
1	363A00000X	Physician Assistant	061843-1	NY

General Provider Information

NPI Number	:	1629402417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN TEMPLETON PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	50 ACKERLY POND LN
Second Line	:	PO BOX 1437
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-0938
Country	:	US
Telephone Number	:	631-765-1414
Fax Number	:	631-765-1428

Provider Business Practice Location Address
First Line	:	50 ACKERLY POND LN
Second Line	:
City	:	SOUTHOLD
State	:	NY
Zip	:	11971-3005
Country	:	US
Telephone Number	:	631-765-1414
Fax Number	:	631-765-1428

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	06/17/2014

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