MEDICARE: SEL MEDICAL PC

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	207Q00000X	Family Medicine Physician	199824	NY

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	:	1942339221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEL MEDICAL PC

Provider Business Mailing Address
First Line	:	1 SMITH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5111
Country	:	US
Telephone Number	:	718-875-1142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 SMITH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5111
Country	:	US
Telephone Number	:	718-875-1142
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KARL E. LATORTUE
Credential	:	M.D.
Telephone Number	:	718-875-4200

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/21/2011

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Directions to “SEL MEDICAL PC ” Practice Location

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