Provider Demographics
NPI:1386912053
Name:SEAN E MCCANCE MD PLLC
Entity type:Organization
Organization Name:SEAN E MCCANCE MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:VILMA
Authorized Official - Middle Name:S
Authorized Official - Last Name:DIMARCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-360-6500
Mailing Address - Street 1:1155 PARK AVENUE
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1209
Mailing Address - Country:US
Mailing Address - Phone:212-360-6500
Mailing Address - Fax:212-360-6535
Practice Address - Street 1:1155 PARK AVENUE
Practice Address - Street 2:SUITE E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1209
Practice Address - Country:US
Practice Address - Phone:212-360-6500
Practice Address - Fax:212-360-6535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206625-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
77G591Medicare PIN