MEDICARE: MR. SEBASTIAN VINCENT MARTORANA 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	010423	NY
2	363AM0700X	Medical Physician Assistant	010423	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4937930001	OTHER	NY	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	080821000023	OTHER	NY	FIDELIS
4	000411920002	OTHER	NY	BSNENY
5	6019223	OTHER	NY	MVP HEALTHCARE

General Provider Information

NPI Number	:	1548206956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SEBASTIAN VINCENT MARTORANA RPA-C

Provider Business Mailing Address
First Line	:	711 TROY SCHENECTADY RD STE 203
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2461
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	2524 ROUTE 9W
Second Line	:
City	:	RAVENA
State	:	NY
Zip	:	12143-2804
Country	:	US
Telephone Number	:	518-756-7390
Fax Number	:	518-756-8030

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	01/25/2018

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Directions to “ MR. SEBASTIAN VINCENT MARTORANA RPA-C” Practice Location

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