Provider Demographics
NPI:1124100789
Name:SELDIN, YEVGENIY (LAC)
Entity type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:
Last Name:SELDIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 MOSELY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-4114
Mailing Address - Country:US
Mailing Address - Phone:646-546-8701
Mailing Address - Fax:718-667-1945
Practice Address - Street 1:2305 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3231
Practice Address - Country:US
Practice Address - Phone:718-667-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
NY000998171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist