Provider Demographics
NPI:1013068279
Name:MCCANCE, SEAN E (MD)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:E
Last Name:MCCANCE
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 1:1155 PARK AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-360-6500
Mailing Address - Fax:212-360-6535
Practice Address - Street 1:1155 PARK AVE
Practice Address - Street 2:SUITE E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-360-6500
Practice Address - Fax:212-360-6535
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY206625-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG32543Medicare UPIN
NY77G591Medicare UPIN
6252780001Medicare NSC