MEDICARE: MR. SANEESE STEPHEN RPA-C

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	006703	NY

General Provider Information

NPI Number	:	1477537025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANEESE STEPHEN RPA-C

Provider Business Mailing Address
First Line	:	224-21 HILLSIDE AVE
Second Line	:
City	:	BELLEROSE
State	:	NY
Zip	:	11427
Country	:	US
Telephone Number	:	718-245-2808
Fax Number	:	718-735-4163

Provider Business Practice Location Address
First Line	:	451 CLARKSON AVE
Second Line	:	H3, KINGS COUNTY HOSPITAL CENTER
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2057
Country	:	US
Telephone Number	:	718-245-2808
Fax Number	:	718-735-4165

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/08/2007

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