MEDICARE: MS. JOAN VENEROSA 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	363A00000X	Physician Assistant	0010571	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	491537001	OTHER	NY	BCBS U/W
2	318412	OTHER	NY	MVP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386629483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOAN VENEROSA PA

Provider Business Mailing Address
First Line	:	427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Second Line	:	ST. MARY'S HOSPITAL AT AMSTERDAM
City	:	AMSTERDAM
State	:	NY
Zip	:	12010
Country	:	US
Telephone Number	:	518-841-7430
Fax Number	:	518-841-7121

Provider Business Practice Location Address
First Line	:	700 S. PERRY ST.
Second Line	:	ST. MARY'S HOSPITAL FAM HLTH CNTR AT JOHNSTOWN PEDIATRI
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095
Country	:	US
Telephone Number	:	518-762-3161
Fax Number	:	518-762-6751

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

Provider Enumeration Date	:	12/12/2005
Last Update Date	:	09/02/2010

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Directions to “ MS. JOAN VENEROSA PA” Practice Location

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