Healthcare Provider Details

I. General information

NPI: 1386735454
Provider Name (Legal Business Name): RICHARD M SELDES M D P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ROSE HAVEN LN
ROCKLEIGH NJ
07647-2720
US

IV. Provider business mailing address

PO BOX 27881
NEW YORK NY
10087-7881
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-1367
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number216190
License Number StateNY

VIII. Authorized Official

Name: AMANTINA LORA
Title or Position: OFFICE MANAGER
Credential:
Phone: 212-604-1367