Provider Demographics
NPI:1336450006
Name:SELEM CENTER, LLC
Entity Type:Organization
Organization Name:SELEM CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SELEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-444-0221
Mailing Address - Street 1:609 CADAGUA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1711
Mailing Address - Country:US
Mailing Address - Phone:305-492-5536
Mailing Address - Fax:
Practice Address - Street 1:814 PONCE DE LEON BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3049
Practice Address - Country:US
Practice Address - Phone:305-444-0221
Practice Address - Fax:305-444-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 103925207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty