Provider Demographics
NPI:1205863917
Name:WARSHONA, MICHAEL J (PA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WARSHONA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-0809
Mailing Address - Country:US
Mailing Address - Phone:800-345-0064
Mailing Address - Fax:973-251-1109
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:@ ST. PETER'S HOSPITAL ER DEPT.
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1324
Practice Address - Fax:518-383-4223
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2008-12-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY000944-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02163880Medicaid
NYS91446Medicare UPIN