Provider Demographics
NPI:1386629483
Name:VENEROSA, JOAN (PA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:
Last Name:VENEROSA
Suffix:
Gender:F
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE - PRIMARY & SPECIALTY CARE DEPT.
Mailing Address - Street 2:ST. MARY'S HOSPITAL AT AMSTERDAM
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-841-7430
Mailing Address - Fax:518-841-7121
Practice Address - Street 1:700 S. PERRY ST.
Practice Address - Street 2:ST. MARY'S HOSPITAL FAM HLTH CNTR AT JOHNSTOWN PEDIATRI
Practice Address - City:JOHNSTOWN
Practice Address - State:NY
Practice Address - Zip Code:12095
Practice Address - Country:US
Practice Address - Phone:518-762-3161
Practice Address - Fax:518-762-6751
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2010-09-02
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Provider Licenses
StateLicense IDTaxonomies
NY0010571363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY491537001OtherBCBS U/W
NY318412OtherMVP
NY02327282Medicaid
NY318412OtherMVP
S56970Medicare UPIN