Provider Demographics
NPI:1578589164
Name:SEDLACKOVA, MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:
Last Name:SEDLACKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4713
Mailing Address - Country:US
Mailing Address - Phone:212-598-6429
Mailing Address - Fax:212-598-6512
Practice Address - Street 1:318 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4713
Practice Address - Country:US
Practice Address - Phone:212-598-6429
Practice Address - Fax:212-598-6512
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193561-1207R00000X
NY193561207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
193561OtherHIP
193561OtherHIP
NY744361Medicare UPIN