Provider Demographics
NPI:1316107204
Name:SEDGH, SEPIDEH (DO)
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:SEDGH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N VILLAGE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-2300
Mailing Address - Country:US
Mailing Address - Phone:516-536-8151
Mailing Address - Fax:516-536-8153
Practice Address - Street 1:200 N VILLAGE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-2300
Practice Address - Country:US
Practice Address - Phone:516-536-8151
Practice Address - Fax:516-536-8153
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY264403-1207R00000X
NY264403207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine