Active NPI
Thomas Elden Sedlock, M.D.
- Psychiatry Physician
- New York, NY
National Provider Identifier
1205046034
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 106132
- Practice address
- 255 W 88TH St
New York, NY 10024-1716 - Phone
- (212) 580-8800
- NPI assigned
- May 23, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychoanalyst | 102L00000X | |||
| Marriage & Family Therapist | 106H00000X | |||
| Psychiatry Physician | 2084P0800X | 106132 | NY | Primary |
| Clinical Pharmacology Physician | 208U00000X | 106132 | NY | |
| Pain Medicine Physician | 208VP0000X | 106132 | NY |
Addresses
Primary practice location
255 W 88TH St
New York, NY 10024-1716
Mailing address
255 W 88TH St
New York, NY 10024-1716
Phone (212) 580-8800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00186094046 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 106132 | NY | MD | Clinical Pharmacology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179878400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1205046034",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "255 W 88TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100241716",
"telephone_number": "212-580-8800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 W 88TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100241716",
"telephone_number": "212-580-8800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEDLOCK",
"first_name": "THOMAS",
"middle_name": "ELDEN",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-23",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "NY",
"license": "106132",
"primary": true
},
{
"code": "208U00000X",
"taxonomy_group": "",
"desc": "Clinical Pharmacology",
"state": "NY",
"license": "106132",
"primary": false
},
{
"code": "208VP0000X",
"taxonomy_group": "",
"desc": "Pain Medicine, Pain Medicine",
"state": "NY",
"license": "106132",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00186094046",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.