Provider Demographics
NPI:1922583129
Name:INGRASSIA, STEVEN ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:ANTHONY
Last Name:INGRASSIA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARIA LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3847
Mailing Address - Country:US
Mailing Address - Phone:917-301-9833
Mailing Address - Fax:
Practice Address - Street 1:706 BANNER AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6957
Practice Address - Country:US
Practice Address - Phone:718-368-3092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022585363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant