Provider Demographics
NPI:1457515660
Name:SELTZER, JARED IAN
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:IAN
Last Name:SELTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL HOUSE STAFF OFFICE
Mailing Address - Street 2:STONY BROOK UNIVERISTY HOSPITAL
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-7148
Mailing Address - Country:US
Mailing Address - Phone:631-444-2754
Mailing Address - Fax:631-444-6031
Practice Address - Street 1:MEDICAL HOUSE STAFF OFFICE
Practice Address - Street 2:STONY BROOK UNIVERISTY HOSPITAL
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-7148
Practice Address - Country:US
Practice Address - Phone:631-444-2754
Practice Address - Fax:631-444-6031
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program