Provider Demographics
NPI:1922287218
Name:SELDEN PRIMARY MEDICINE,P.C.
Entity Type:Organization
Organization Name:SELDEN PRIMARY MEDICINE,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:WEBLEY-BETHUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-736-7220
Mailing Address - Street 1:12 NEW LN
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3322
Mailing Address - Country:US
Mailing Address - Phone:631-736-7220
Mailing Address - Fax:631-736-7307
Practice Address - Street 1:12 NEW LN
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3322
Practice Address - Country:US
Practice Address - Phone:631-736-7220
Practice Address - Fax:631-736-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY063AD1OtherEMPIRE BLUE CROSS/SHIELD
NY01693356Medicaid
NY1518962000OtherINDIVIDUAL NPI NUMBER
NY01693356Medicaid