MEDICARE: DR. MARY SEDAROUS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	25MA09068100	NJ

General Provider Information

NPI Number	:	1114187465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY SEDAROUS M.D.

Provider Business Mailing Address
First Line	:	1945 CORLIES AVE
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	732-897-3600
Fax Number	:	732-897-3660

Provider Business Practice Location Address
First Line	:	1945 CORLIES AVE
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-5197
Country	:	US
Telephone Number	:	732-897-3600
Fax Number	:	732-897-3660

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	08/02/2024

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