Provider Demographics
NPI:1205052180
Name:SELKIN, STUART GERALD (MD JD)
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:GERALD
Last Name:SELKIN
Suffix:
Gender:M
Credentials:MD JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 WALT WHITMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-692-7362
Mailing Address - Fax:631-692-7546
Practice Address - Street 1:801 WALT WHITMAN ROAD
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747
Practice Address - Country:US
Practice Address - Phone:631-692-7362
Practice Address - Fax:631-692-7546
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD 098873207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWCB 222483OtherWORKMANS COMP
NYWCB 222483OtherWORKMANS COMP
566671Medicare ID - Type Unspecified