Provider Demographics
NPI:1740334614
Name:JONATHAN SELZER MD PC
Entity type:Organization
Organization Name:JONATHAN SELZER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-884-2300
Mailing Address - Street 1:2735 HENRY HUDSON PARKWAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:718-884-2300
Mailing Address - Fax:718-884-0843
Practice Address - Street 1:2735 HENRY HUDSON PARKWAY
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463
Practice Address - Country:US
Practice Address - Phone:718-884-2300
Practice Address - Fax:718-884-0843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187582207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01704654Medicaid
NY01704654Medicaid
NY220321Medicare ID - Type Unspecified