Provider Demographics
NPI:1093284994
Name:FOURNIER, SEBASTIEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIEN
Middle Name:
Last Name:FOURNIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361, RUE RENE-RICHARD
Mailing Address - Street 2:
Mailing Address - City:LEVIS
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:G6J 0A7
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 STONELEDGE DR APT 11
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-3519
Practice Address - Country:US
Practice Address - Phone:518-727-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic