Provider Demographics
NPI:1558003442
Name:BELLOTTI, SEBASTIAN ERICK (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:SEBASTIAN
Middle Name:ERICK
Last Name:BELLOTTI
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 PINE CT
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-1628
Mailing Address - Country:US
Mailing Address - Phone:908-524-5722
Mailing Address - Fax:
Practice Address - Street 1:475 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3436
Practice Address - Country:US
Practice Address - Phone:718-226-8313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program