Provider Demographics
NPI:1417224130
Name:SELZNICK, DANA (MED MA)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:SELZNICK
Suffix:
Gender:F
Credentials:MED MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W 43RD ST
Mailing Address - Street 2:APARTMENT 4F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:560 W 43RD ST
Practice Address - Street 2:APARTMENT 4F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4300
Practice Address - Country:US
Practice Address - Phone:407-697-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2364750237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist