Provider Demographics
NPI:1982678199
Name:SELENOW, ARKADY (OD)
Entity Type:Individual
Prefix:DR
First Name:ARKADY
Middle Name:
Last Name:SELENOW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 EAST 56TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10022
Mailing Address - Country:US
Mailing Address - Phone:212-688-4277
Mailing Address - Fax:212-421-2411
Practice Address - Street 1:160 E 56TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-3609
Practice Address - Country:US
Practice Address - Phone:212-688-4277
Practice Address - Fax:212-421-2411
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003921-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC48431Medicare PIN
NY01210HMedicare PIN
U16709Medicare UPIN