Healthcare Provider Details

I. General information

NPI: 1467691220
Provider Name (Legal Business Name): JOHN RAYMOND ANNESSA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MIDDLE SETTLEMENT RD STE 102
NEW HARTFORD NY
13413-5332
US

IV. Provider business mailing address

4401 MIDDLE SETTLEMENT RD STE 102
NEW HARTFORD NY
13413-5332
US

V. Phone/Fax

Practice location:
  • Phone: 315-735-4496
  • Fax: 315-735-7066
Mailing address:
  • Phone: 315-735-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008688
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: