Provider Demographics
NPI:1720561129
Name:SEDDIK, MATHEW (PHARMD)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:
Last Name:SEDDIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4594
Mailing Address - Country:US
Mailing Address - Phone:718-932-9200
Mailing Address - Fax:718-932-4996
Practice Address - Street 1:2125 BROADWAY
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11106-4594
Practice Address - Country:US
Practice Address - Phone:718-932-9200
Practice Address - Fax:718-932-4996
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYI064560-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist