Provider Demographics
NPI:1457360026
Name:SELDMAN, ERNESTO DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:DANIEL
Last Name:SELDMAN
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 1:4037 76TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1033
Mailing Address - Country:US
Mailing Address - Phone:718-446-4192
Mailing Address - Fax:718-899-9769
Practice Address - Street 1:4037 76TH ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1033
Practice Address - Country:US
Practice Address - Phone:718-446-4192
Practice Address - Fax:718-899-9769
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB88774Medicare UPIN