Provider Demographics
NPI:1073003885
Name:SELENOW, EMILY (OD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:SELENOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 WARBURTON AVE APT 217
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1174
Mailing Address - Country:US
Mailing Address - Phone:585-662-3202
Mailing Address - Fax:
Practice Address - Street 1:210 E 64TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7471
Practice Address - Country:US
Practice Address - Phone:212-702-7620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-16
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist