Provider Demographics
NPI:1114063864
Name:SADEK, HENRY (DO)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:SADEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N KINGS HIGHWAY SUITE #410
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-755-3500
Mailing Address - Fax:856-755-3552
Practice Address - Street 1:800 N KINGS HIGHWAY
Practice Address - Street 2:SUITE 410
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-755-3500
Practice Address - Fax:856-755-3552
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07571700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98684Medicare UPIN
SA129916MCMedicare ID - Type Unspecified