Basic Information
| Provider Information | |||||||||
| NPI: | 1548206956 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARTORANA | ||||||||
| FirstName: | SEBASTIAN | ||||||||
| MiddleName: | VINCENT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 TROY SCHENECTADY RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | LATHAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121102461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187823700 | ||||||||
| FaxNumber: | 5187823799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2524 ROUTE 9W | ||||||||
| Address2: | |||||||||
| City: | RAVENA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 121432804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187567390 | ||||||||
| FaxNumber: | 5187568030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2006 | ||||||||
| LastUpdateDate: | 01/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 010423 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 010423 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 4937930001 | 01 | NY | MEDICARE DME | OTHER | 02982492 | 05 | NY | MEDICAID | 080821000023 | 01 | NY | FIDELIS | OTHER | 000411920002 | 01 | NY | BSNENY | OTHER | 6019223 | 01 | NY | MVP HEALTHCARE | OTHER |