Provider Demographics
NPI:1982627873
Name:MAYER, SEBASTIAN ALEXANDER A (MD)
Entity Type:Individual
Prefix:
First Name:SEBASTIAN ALEXANDER
Middle Name:A
Last Name:MAYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:GPO BOX 5907
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5907
Mailing Address - Country:US
Mailing Address - Phone:212-746-6264
Mailing Address - Fax:212-746-3305
Practice Address - Street 1:520 E. 70TH STREET
Practice Address - Street 2:STARR 3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-241-6756
Practice Address - Fax:212-731-5220
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230196207RH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801572Medicaid