Provider Demographics
NPI:1346202306
Name:SELBS, ELENA (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:SELBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 STATION PLZ N
Mailing Address - Street 2:SUITE 606
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3808
Mailing Address - Country:US
Mailing Address - Phone:516-663-2468
Mailing Address - Fax:516-663-8824
Practice Address - Street 1:222 STATION PLZ N
Practice Address - Street 2:SUITE 606
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3808
Practice Address - Country:US
Practice Address - Phone:516-663-2468
Practice Address - Fax:516-663-8824
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223568207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02524349Medicaid
56R671Medicare ID - Type Unspecified
I12905Medicare UPIN