MEDICARE: CHRISTOPHER PREZZANO PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	010549	NY

General Provider Information

NPI Number	:	1063448496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER PREZZANO PA

Provider Business Mailing Address
First Line	:	45 READE PL
Second Line	:
City	:	POUGHKEEPSIE
State	:	NY
Zip	:	12601-3947
Country	:	US
Telephone Number	:	845-483-6217
Fax Number	:	845-483-6108

Provider Business Practice Location Address
First Line	:	737 PARK AVE APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10021-4264
Country	:	US
Telephone Number	:	845-857-4994
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	01/12/2023

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