Healthcare Provider Details

I. General information

NPI: 1265130967
Provider Name (Legal Business Name): SELINA JEAN LENETSKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SELINA JEAN MARKES

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 10/06/2023
Certification Date: 08/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HARRIS B DATES DR
ITHACA NY
14850-1383
US

IV. Provider business mailing address

101 HARRIS B DATES DR
ITHACA NY
14850-1383
US

V. Phone/Fax

Practice location:
  • Phone: 607-252-3248
  • Fax: 607-274-4130
Mailing address:
  • Phone: 607-252-3248
  • Fax: 607-274-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number750794
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: