Healthcare Provider Details

I. General information

NPI: 1255676912
Provider Name (Legal Business Name): CORTNEY SEKERKA MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 11/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WOODROW RD
STATEN ISLAND NY
10312-1313
US

IV. Provider business mailing address

80 WOODROW RD
STATEN ISLAND NY
10312-1313
US

V. Phone/Fax

Practice location:
  • Phone: 718-356-0008
  • Fax: 718-356-6566
Mailing address:
  • Phone: 718-356-0008
  • Fax: 718-356-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number1136890
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: