Provider Demographics
NPI:1366403503
Name:ASTAIRE K. SELASSIE, MD, PC
Entity type:Organization
Organization Name:ASTAIRE K. SELASSIE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASTAIRE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SELASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-922-0950
Mailing Address - Street 1:PO BOX 951
Mailing Address - Street 2:LENOX HILL STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-0003
Mailing Address - Country:US
Mailing Address - Phone:212-922-0950
Mailing Address - Fax:212-922-9316
Practice Address - Street 1:345 E 37TH ST
Practice Address - Street 2:#321
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3256
Practice Address - Country:US
Practice Address - Phone:212-922-0950
Practice Address - Fax:212-922-9316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW31151Medicare ID - Type Unspecified