MEDICARE: SELDEN PRIMARY MEDICINE,P.C.

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	207R00000X	Internal Medicine Physician	182907	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	063AD1	OTHER	NY	EMPIRE BLUE CROSS/SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1518962000	OTHER	NY	INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1922287218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SELDEN PRIMARY MEDICINE,P.C.

Provider Business Mailing Address
First Line	:	12 NEW LN
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-3322
Country	:	US
Telephone Number	:	631-736-7220
Fax Number	:	631-736-7307

Provider Business Practice Location Address
First Line	:	12 NEW LN
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-3322
Country	:	US
Telephone Number	:	631-736-7220
Fax Number	:	631-736-7307

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATRICIA ELAINE WEBLEY-BETHUNE
Credential	:	M.D.
Telephone Number	:	631-736-7220

Provider Enumeration Date	:	11/02/2007
Last Update Date	:	11/02/2007

Similar Medicare Providers

1518962000 — DR. PATRICIA WEBLEY-BETHUNE M.D.
Practice Location Address:

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1851411573 — DR. HAROLD THIBOU JOSEPH MD
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1801744743 — SYED NUMAN LLC
Practice Location Address:

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1932056942 — CIERRA DOROTHY WOLFGRAM
Practice Location Address:

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