Provider Demographics
NPI:1780082644
Name:SELTZER, MATTHEW IAN (DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:IAN
Last Name:SELTZER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 30TH DR APT 2F
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11102-2733
Mailing Address - Country:US
Mailing Address - Phone:631-896-3821
Mailing Address - Fax:
Practice Address - Street 1:1384 BROADWAY STE 606
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6108
Practice Address - Country:US
Practice Address - Phone:631-896-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038508-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist