Provider Demographics
NPI:1942506910
Name:SAHAGUN, ANTONIO JR (PA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:SAHAGUN
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 E MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-5231
Mailing Address - Country:US
Mailing Address - Phone:516-225-5073
Mailing Address - Fax:
Practice Address - Street 1:347 STOCKHOLM STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:718-907-8370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012133-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant