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General NPI Number Information
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NPI Number | 1033269915
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Entity Type | Organization
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Legal Business Name | SELEVANY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 1003 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2333
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Country | US
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Telephone | 973-777-9595
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Fax | 973-777-1311
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Provider Business Mailing Address
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Address Line | 1003 MAIN AVE
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City | CLIFTON
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State | NJ
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Zip | 07011-2333
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Country | US
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Telephone | 973-777-9595
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Fax | 973-777-1311
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MUHAMMAD TAHIR SELEVANY
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Credential | M.D
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Telephone | 973-777-9595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25MA06471000
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License Number State | NJ
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