Healthcare Provider Details

I. General information

NPI: 1992004436
Provider Name (Legal Business Name): JEAN MARIE SEFCOVIC NYS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 03/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 FOURTEENTH ST
SCHENECTADY NY
12306-2414
US

IV. Provider business mailing address

232 FOURTEENTH ST
SCHENECTADY NY
12306-2414
US

V. Phone/Fax

Practice location:
  • Phone: 518-527-6070
  • Fax:
Mailing address:
  • Phone: 518-527-6070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number022449
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: