MEDICARE: EM-SAPA

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		NY

General Provider Information

NPI Number	:	1245407303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EM-SAPA

Provider Business Mailing Address
First Line	:	19 CLAYTON DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5503
Country	:	US
Telephone Number	:	631-944-2788
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 CLAYTON DR
Second Line	:
City	:	DIX HILLS
State	:	NY
Zip	:	11746-5503
Country	:	US
Telephone Number	:	631-944-2788
Fax Number	:

Authorized Official
Title or Position	:	PA
Name	:	JOSE VENTURA
Credential	:	PA
Telephone Number	:	631-944-2788

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	07/21/2022

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Directions to “EM-SAPA ” Practice Location

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