Healthcare Provider Details

I. General information

NPI: 1881700532
Provider Name (Legal Business Name): JEFFREY D. SELEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 AMERICAN AVE STE 302
KING OF PRUSSIA PA
19406-4023
US

IV. Provider business mailing address

109 W 27TH ST RM 5S
NEW YORK NY
10001-6208
US

V. Phone/Fax

Practice location:
  • Phone: 917-634-5311
  • Fax:
Mailing address:
  • Phone: 917-634-5311
  • Fax: 888-815-3583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberMD-070809-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberMD-070809-L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberMD-070809-L
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberMD-070809-L
License Number StatePA
# 5
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberMD-070809-L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberMD-070809-L
License Number StatePA
# 7
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberMD-070809-L
License Number StatePA
# 8
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD-070809-L
License Number StatePA
# 9
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-070809-L
License Number StatePA
# 10
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD-070809-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: