Provider Demographics
NPI:1477996189
Name:SEDHOM, GEORGE (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SEDHOM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 64TH ST
Mailing Address - Street 2:APT :A3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5551
Mailing Address - Country:US
Mailing Address - Phone:917-443-5290
Mailing Address - Fax:
Practice Address - Street 1:969 64TH ST
Practice Address - Street 2:APT :A3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5551
Practice Address - Country:US
Practice Address - Phone:917-443-5290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016501363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical