# ST. SEBASTIAN MEDICAL PC

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

## Provider details

- **NPI number:** 1720513427
- **Authorized official:** ALEXANDER VERONA BALDONADO MD (OWNER)
- **Authorized official phone:** (718) 657-0412

## Contact information

- **Practice address:** 16836 JAMAICA AVE, JAMAICA, NY 11432-5216
- **Practice address phone:** (718) 657-0412
- **Practice address fax:** (718) 657-0415
- **Mailing address:** 16836 JAMAICA AVE, JAMAICA, NY 11432-5216
- **Mailing address phone:** (718) 657-0412
- **Mailing address fax:** (718) 657-0415

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2017
- **Last updated:** 05/01/2017