Provider Demographics
NPI:1659969319
Name:SELOVER, DAVID GREER (ATP)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:GREER
Last Name:SELOVER
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8246 DEXTER PKWY
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-1007
Mailing Address - Country:US
Mailing Address - Phone:315-516-3376
Mailing Address - Fax:
Practice Address - Street 1:8246 DEXTER PKWY
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1007
Practice Address - Country:US
Practice Address - Phone:315-516-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYATP90782171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications