Provider Demographics
NPI:1831400316
Name:SIDECO, MARLON (CRT)
Entity type:Individual
Prefix:MR
First Name:MARLON
Middle Name:
Last Name:SIDECO
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 WALLINGFORD TER
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-7327
Mailing Address - Country:US
Mailing Address - Phone:908-687-1856
Mailing Address - Fax:
Practice Address - Street 1:433 WALLINGFORD TER
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-7327
Practice Address - Country:US
Practice Address - Phone:908-687-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-29
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ432A00324000227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified