Healthcare Provider Details

I. General information

NPI: 1407854664
Provider Name (Legal Business Name): PAUL SELINGER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6503 MYRTLE AVE
GLENDALE NY
11385-6248
US

IV. Provider business mailing address

6503 MYRTLE AVE
GLENDALE NY
11385-6248
US

V. Phone/Fax

Practice location:
  • Phone: 718-456-0360
  • Fax:
Mailing address:
  • Phone: 718-456-0360
  • Fax: 718-813-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number029253-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: