Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 136326 | NY |
N | 2080P0210X | Pediatric Nephrologist | 136326 | NY |
NPI | 1720088503 |
---|---|
Provider Name | Dr. Reid V Selden |
First Address | Islandia, NY 11749-5301 |
Second Address | Islandia, NY 11749-5301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2005 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B79459 | (02) | NY |