Provider Demographics
NPI:1356778310
Name:SEBESTA, MARK SR
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:SEBESTA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2141 34TH AVE APT 2C
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4356
Mailing Address - Country:US
Mailing Address - Phone:855-455-8446
Mailing Address - Fax:
Practice Address - Street 1:2141 34TH AVE APT 2C
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4356
Practice Address - Country:US
Practice Address - Phone:855-455-8446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies