Healthcare Provider Details

I. General information

NPI: 1528228343
Provider Name (Legal Business Name): DR. AZIZA S SEDRAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LUCY SEDRAK MD

II. Dates (important events)

Enumeration Date: 06/16/2008
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

IV. Provider business mailing address

121 DEKALB AVE
BROOKLYN NY
11201-5425
US

V. Phone/Fax

Practice location:
  • Phone: 718-250-6074
  • Fax: 718-250-6518
Mailing address:
  • Phone: 718-250-6074
  • Fax: 718-250-6518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number226480
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: