Provider Demographics
NPI:1700191582
Name:SELINA, ELENA V (MD)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:V
Last Name:SELINA
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 1:48 S NEW YORK RD STE B3
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9676
Mailing Address - Country:US
Mailing Address - Phone:609-404-0121
Mailing Address - Fax:609-404-0131
Practice Address - Street 1:48 S NEW YORK RD STE B3
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9676
Practice Address - Country:US
Practice Address - Phone:609-404-0121
Practice Address - Fax:609-404-0131
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08815700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine