# ST SEBASTIAN MEDICAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558722546
- **Authorized official:** ALEXSANDER V BALDONADO (MD)
- **Authorized official phone:** (347) 397-7563

## Contact information

- **Practice address:** 20 W 190TH ST \# W, BRONX, NY 10468-4356
- **Practice address phone:** (999) 999-9999
- **Mailing address:** 20 W 190TH ST \# W, BRONX, NY 10468-4356

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 03/17/2016
- **Last updated:** 03/17/2016