Healthcare Provider Details

I. General information

NPI: 1245291459
Provider Name (Legal Business Name): ASTAIRE K SELASSIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E 37TH ST #321
NEW YORK NY
10016-3256
US

IV. Provider business mailing address

PO BOX 951 LENOX HILL STATION
NEW YORK NY
10021-0003
US

V. Phone/Fax

Practice location:
  • Phone: 212-922-0950
  • Fax: 212-922-9316
Mailing address:
  • Phone: 212-922-0950
  • Fax: 212-922-9316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number185998
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: