Provider Demographics
NPI:1023398096
Name:SELAN, CAITLIN E (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:E
Last Name:SELAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 HIGH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9605
Mailing Address - Country:US
Mailing Address - Phone:973-579-2100
Mailing Address - Fax:
Practice Address - Street 1:222 HIGH ST STE 205
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9605
Practice Address - Country:US
Practice Address - Phone:973-579-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00264200363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical