Provider Demographics
NPI:1992004436
Name:SEFCOVIC, JEAN MARIE (NYS LMT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:SEFCOVIC
Suffix:
Gender:F
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 FOURTEENTH ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-2414
Mailing Address - Country:US
Mailing Address - Phone:518-527-6070
Mailing Address - Fax:
Practice Address - Street 1:232 FOURTEENTH ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-2414
Practice Address - Country:US
Practice Address - Phone:518-527-6070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist