Healthcare Provider Details

I. General information

NPI: 1528294030
Provider Name (Legal Business Name): HEN YITZHAK SELA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 04/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5141 BROADWAY
NEW YORK NY
10034-1159
US

IV. Provider business mailing address

622 W 168TH ST PH 16
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-932-4200
  • Fax:
Mailing address:
  • Phone: 212-305-4098
  • Fax: 212-305-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number003335-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: