Provider Demographics
NPI:1487282133
Name:SELIGER, JUSTINE LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:LYNN
Last Name:SELIGER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 STATE ROUTE 32 SUITE 4
Mailing Address - Street 2:
Mailing Address - City:MODENA
Mailing Address - State:NY
Mailing Address - Zip Code:12548
Mailing Address - Country:US
Mailing Address - Phone:845-883-5176
Mailing Address - Fax:845-883-5177
Practice Address - Street 1:2044 STATE ROUTE 32 STE 4
Practice Address - Street 2:
Practice Address - City:MODENA
Practice Address - State:NY
Practice Address - Zip Code:12548-5021
Practice Address - Country:US
Practice Address - Phone:845-883-5176
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025636363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty