Healthcare Provider Details

I. General information

NPI: 1003178252
Provider Name (Legal Business Name): ANNETTE SELIG MS ED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 DAMASCUS DR
GANSEVOORT NY
12831-1454
US

IV. Provider business mailing address

71 DAMASCUS DR
GANSEVOORT NY
12831-1454
US

V. Phone/Fax

Practice location:
  • Phone: 518-421-1060
  • Fax:
Mailing address:
  • Phone: 518-421-1060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: