Healthcare Provider Details

I. General information

NPI: 1346488509
Provider Name (Legal Business Name): RAYMUND SESE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RAYMUND SESE PA

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 LENOX RD
BROOKLYN NY
11203-2020
US

IV. Provider business mailing address

379 GERRY RD
NORTH BRUNSWICK NJ
08902-3210
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-4217
  • Fax:
Mailing address:
  • Phone: 732-951-8973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004916
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: