Healthcare Provider Details

I. General information

NPI: 1780133488
Provider Name (Legal Business Name): SELINA ALBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 12/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ORCHARD ST 3J
HACKENSACK NJ
07601-4830
US

IV. Provider business mailing address

129 STERLING AVE
JERSEY CITY NJ
07305-1405
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-5716
  • Fax:
Mailing address:
  • Phone: 201-956-8838
  • Fax: 201-880-5716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: