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General NPI Number Information
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NPI Number | 1487912374
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Entity Type | Organization
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Legal Business Name | CLAUDIA J SELGRAD DO PC
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Dates
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Enumeration Date | 04/27/2012
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Last Update Date | 06/25/2012
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Provider Practice Location Address
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Address Line | 1555 SUNRISE HWY SUITE #6
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City | BAY SHORE
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State | NY
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Zip | 11706-6027
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Country | US
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Telephone | 631-968-0588
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Fax | 631-968-2848
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Provider Business Mailing Address
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Address Line | 1555 SUNRISE HWY SUITE #6
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City | BAY SHORE
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State | NY
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Zip | 11706-6027
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Country | US
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Telephone | 631-968-0588
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Fax | 631-968-2848
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Authorized Official
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Title or Position | D.O./OWNER
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Name | CLAUDIA J. SELGRAD
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Credential | D.O.
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Telephone | 631-968-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 200616
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License Number State | NY
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