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General NPI Number Information
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NPI Number | 1245407303
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Entity Type | Organization
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Legal Business Name | EM-SAPA
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 19 CLAYTON DR
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City | DIX HILLS
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State | NY
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Zip | 11746-5503
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Country | US
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Telephone | 631-944-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 19 CLAYTON DR
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City | DIX HILLS
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State | NY
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Zip | 11746-5503
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Country | US
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Telephone | 631-944-2788
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Fax |
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Authorized Official
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Title or Position | PA
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Name | JOSE VENTURA
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Credential | PA
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Telephone | 631-944-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State | NY
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