Provider Demographics
NPI:1386905362
Name:SEO, FELIX R
Entity type:Individual
Prefix:MR
First Name:FELIX
Middle Name:R
Last Name:SEO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1145
Mailing Address - Country:US
Mailing Address - Phone:201-840-7764
Mailing Address - Fax:201-840-7786
Practice Address - Street 1:481 RIVER RD
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:07020-1145
Practice Address - Country:US
Practice Address - Phone:201-840-7764
Practice Address - Fax:201-840-7786
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI20017183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist