Healthcare Provider Details

I. General information

NPI: 1588739668
Provider Name (Legal Business Name): JOHN SESTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PATERSON ST CLINICAL ACADEMIC BUILDING - SUITE 4200
NEW BRUNSWICK NJ
08901-1962
US

IV. Provider business mailing address

66 WEST GILBERT ST
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-6600
  • Fax:
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMA029859
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: