Provider Demographics
NPI:1487912374
Name:CLAUDIA J SELGRAD DO PC
Entity type:Organization
Organization Name:CLAUDIA J SELGRAD DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELGRAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-968-0588
Mailing Address - Street 1:1555 SUNRISE HWY
Mailing Address - Street 2:SUITE #6
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-6027
Mailing Address - Country:US
Mailing Address - Phone:631-968-0588
Mailing Address - Fax:631-968-2848
Practice Address - Street 1:1555 SUNRISE HWY
Practice Address - Street 2:SUITE #6
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-6027
Practice Address - Country:US
Practice Address - Phone:631-968-0588
Practice Address - Fax:631-968-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200616207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG68269Medicare UPIN