Provider Demographics
NPI:1841238722
Name:SEBASTIANO, WAYNE R (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:R
Last Name:SEBASTIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7439
Mailing Address - Country:US
Mailing Address - Phone:718-386-8300
Mailing Address - Fax:718-386-0437
Practice Address - Street 1:7801 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7439
Practice Address - Country:US
Practice Address - Phone:718-386-8300
Practice Address - Fax:718-386-0437
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0110804OtherGHI
NY04F91OtherBC/BS PROVIDER ID
NYAP133OtherOXFORD ID
NYAP133OtherOXFORD ID