Provider Demographics
NPI:1194787911
Name:SELIGSOHN, AUDREY LYNN (DO)
Entity type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:LYNN
Last Name:SELIGSOHN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 MAIN ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MONTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07045-9250
Mailing Address - Country:US
Mailing Address - Phone:973-299-6300
Mailing Address - Fax:973-299-6304
Practice Address - Street 1:137 MAIN ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:MONTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07045-9250
Practice Address - Country:US
Practice Address - Phone:973-299-6304
Practice Address - Fax:973-299-6304
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07570000207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76292Medicare UPIN
076239ZFCHMedicare PIN