Provider Demographics
NPI:1164711503
Name:M. ROSS SELIGSON, PH.D., P.A.
Entity Type:Organization
Organization Name:M. ROSS SELIGSON, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M. ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:SELIGSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:954-563-2800
Mailing Address - Street 1:915 MIDDLE RIVER DRIVE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3561
Mailing Address - Country:US
Mailing Address - Phone:954-563-2800
Mailing Address - Fax:954-563-9771
Practice Address - Street 1:915 MIDDLE RIVER DRIVE
Practice Address - Street 2:SUITE 520
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3561
Practice Address - Country:US
Practice Address - Phone:954-563-2800
Practice Address - Fax:954-563-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75291AMedicare UPIN