Provider Demographics
NPI:1154407047
Name:SELBY, RONALD M (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:M
Last Name:SELBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-3469
Mailing Address - Country:US
Mailing Address - Phone:732-846-4900
Mailing Address - Fax:732-846-4901
Practice Address - Street 1:330 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-3469
Practice Address - Country:US
Practice Address - Phone:732-846-4900
Practice Address - Fax:732-846-4901
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41641207XX0005X
NY144165207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A62814Medicare UPIN
NY45D211Medicare PIN
NJ460687Medicare PIN