Provider Demographics
NPI:1265130967
Name:LENETSKY, SELINA JEAN (NP)
Entity type:Individual
Prefix:
First Name:SELINA
Middle Name:JEAN
Last Name:LENETSKY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SELINA
Other - Middle Name:JEAN
Other - Last Name:MARKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 HARRIS B DATES DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1383
Mailing Address - Country:US
Mailing Address - Phone:607-252-3248
Mailing Address - Fax:607-274-4130
Practice Address - Street 1:101 HARRIS B DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1383
Practice Address - Country:US
Practice Address - Phone:607-252-3248
Practice Address - Fax:607-274-4130
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY750794163WE0003X
NY404989363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WE0003XNursing Service ProvidersRegistered NurseEmergency