Provider Demographics
NPI:1710522768
Name:SEDLAK, MARK (APN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SEDLAK
Suffix:
Gender:M
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BRISCOE TER
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1127
Mailing Address - Country:US
Mailing Address - Phone:732-497-2262
Mailing Address - Fax:
Practice Address - Street 1:1 BETHANY RD STE 69
Practice Address - Street 2:
Practice Address - City:HAZLET
Practice Address - State:NJ
Practice Address - Zip Code:07730-1668
Practice Address - Country:US
Practice Address - Phone:732-784-8272
Practice Address - Fax:732-838-0829
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995487-NP363LP0808X
NJ26NJ00974000363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health