Provider Demographics
NPI:1306981535
Name:SELITSKY, TAMILA (DO)
Entity type:Individual
Prefix:DR
First Name:TAMILA
Middle Name:
Last Name:SELITSKY
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 1:660 92ND ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-3621
Mailing Address - Country:US
Mailing Address - Phone:718-680-4800
Mailing Address - Fax:718-680-2400
Practice Address - Street 1:660 92ND ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-3621
Practice Address - Country:US
Practice Address - Phone:718-680-4800
Practice Address - Fax:718-680-2400
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234424174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI35587Medicare UPIN