Provider Demographics
NPI:1548206956
Name:MARTORANA, SEBASTIAN VINCENT (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:VINCENT
Last Name:MARTORANA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2524 ROUTE 9W
Practice Address - Street 2:
Practice Address - City:RAVENA
Practice Address - State:NY
Practice Address - Zip Code:12143-2804
Practice Address - Country:US
Practice Address - Phone:518-756-7390
Practice Address - Fax:518-756-8030
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010423363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4937930001OtherMEDICARE DME
NY02982492Medicaid
NY080821000023OtherFIDELIS
NY000411920002OtherBSNENY
NY6019223OtherMVP HEALTHCARE
NY6019223OtherMVP HEALTHCARE
NYPA2565-PA2564Medicare PIN