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General NPI Number Information
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NPI Number | 1942506910
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Entity Type | Individual
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Provider Name | ANTONIO SAHAGUN JR. PA
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Gender | Male
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 02/08/2011
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Provider Practice Location Address
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Address Line | 347 STOCKHOLM STREET
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City | BROOKLYN
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State | NY
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Zip | 11237
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Country | US
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Telephone | 718-907-8370
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Fax |
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Provider Business Mailing Address
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Address Line | 840 E MEADOW AVE
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City | EAST MEADOW
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State | NY
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Zip | 11554-5231
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Country | US
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Telephone | 516-225-5073
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 012133-1
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License Number State | NY
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