Healthcare Provider Details

I. General information

NPI: 1639041130
Provider Name (Legal Business Name): ADRIANE SELOVER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2025
Last Update Date: 09/23/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 S COLLEGE AVENUE
NEWARK DE
19711
US

IV. Provider business mailing address

1057 KEARNEY DR
NORTH BRUNSWICK NJ
08902-3228
US

V. Phone/Fax

Practice location:
  • Phone: 302-831-4006
  • Fax:
Mailing address:
  • Phone: 732-519-2313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: