Provider Demographics
NPI:1194901553
Name:SELTZER, GREGORY IAN (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:IAN
Last Name:SELTZER
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 1:485 WILLIAMSTOWN RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1777
Mailing Address - Country:US
Mailing Address - Phone:856-237-8045
Mailing Address - Fax:856-237-8047
Practice Address - Street 1:485 WILLIAMSTOWN RD
Practice Address - Street 2:SUITE J
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081-1777
Practice Address - Country:US
Practice Address - Phone:856-237-8045
Practice Address - Fax:856-237-8047
Is Sole Proprietor?:No
Enumeration Date:2008-01-16
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432399207R00000X
NJ25MA07859000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0225762Medicaid