Provider Demographics
NPI:1386735454
Name:RICHARD M SELDES M D P C
Entity type:Organization
Organization Name:RICHARD M SELDES M D P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-604-1367
Mailing Address - Street 1:PO BOX 27881
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-7881
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4 ROSE HAVEN LN
Practice Address - Street 2:
Practice Address - City:ROCKLEIGH
Practice Address - State:NJ
Practice Address - Zip Code:07647-2720
Practice Address - Country:US
Practice Address - Phone:212-604-1367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216190207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06076OtherGHI MEDICARE
NJ111860OtherMEDICARE NEW JERSEY
NYP00224589OtherRAILROAD MEDICARE
NYWEN371Medicare PIN