Healthcare Provider Details

I. General information

NPI: 1437013976
Provider Name (Legal Business Name): SEAN KEVIN NOTERFONZO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 PENNSYLVANIA AVE
PINE CITY NY
14871-9245
US

IV. Provider business mailing address

1460 PENNSYLVANIA AVE
PINE CITY NY
14871-9245
US

V. Phone/Fax

Practice location:
  • Phone: 607-333-4881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number347076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: