Provider Demographics
NPI:1265404271
Name:SELZER, JONATHAN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SELZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2735 HENRY HUDSON PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-4745
Mailing Address - Country:US
Mailing Address - Phone:718-884-2300
Mailing Address - Fax:718-884-0843
Practice Address - Street 1:2735 HENRY HUDSON PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-4745
Practice Address - Country:US
Practice Address - Phone:718-884-2300
Practice Address - Fax:718-884-0843
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704654Medicaid
NY01704654Medicaid
NY220321Medicare ID - Type UnspecifiedPROVIDER ID