Provider Demographics
NPI:1093856619
Name:SEDRAK, JOSEPH WELLEN (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WELLEN
Last Name:SEDRAK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DIAMOND LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3323
Mailing Address - Country:US
Mailing Address - Phone:201-888-1549
Mailing Address - Fax:
Practice Address - Street 1:120 DIAMOND LN
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3323
Practice Address - Country:US
Practice Address - Phone:201-888-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2021-07-23
Deactivation Date:2012-10-05
Deactivation Code:
Reactivation Date:2021-05-18
Provider Licenses
StateLicense IDTaxonomies
NY023838174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist