MEDICARE: SAMUEL P SELIMO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MC02363	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336296375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL P SELIMO DC

Provider Business Mailing Address
First Line	:	125 MADISON ST
Second Line	:
City	:	BOONTON
State	:	NJ
Zip	:	07005-2153
Country	:	US
Telephone Number	:	973-299-2430
Fax Number	:	973-299-2433

Provider Business Practice Location Address
First Line	:	125 MADISON ST
Second Line	:
City	:	BOONTON
State	:	NJ
Zip	:	07005-2153
Country	:	US
Telephone Number	:	973-299-2430
Fax Number	:	973-299-2433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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Directions to “ SAMUEL P SELIMO DC” Practice Location

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