Healthcare Provider Details

I. General information

NPI: 1861674053
Provider Name (Legal Business Name): JOEL B SELITSKY RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 11/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 EASTPORT MANOR RD
EASTPORT NY
11941-1410
US

IV. Provider business mailing address

23 EASTPORT MANOR RD
EASTPORT NY
11941-1410
US

V. Phone/Fax

Practice location:
  • Phone: 631-325-0643
  • Fax:
Mailing address:
  • Phone: 631-325-0643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number29675
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: