Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 144165 | NY |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MA41641 | NJ |
NPI | 1154407047 |
---|---|
Provider Name | Ronald M. Selby |
First Address | New Brunswick, NJ 08901-3469 |
Second Address | New Brunswick, NJ 08901-3469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A62814 | (02) |