Provider Demographics
NPI:1871526798
Name:SELTZER, RONNI LEE (MD)
Entity type:Individual
Prefix:DR
First Name:RONNI
Middle Name:LEE
Last Name:SELTZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ENGLE ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2920
Mailing Address - Country:US
Mailing Address - Phone:201-894-0505
Mailing Address - Fax:201-894-5593
Practice Address - Street 1:15 ENGLE ST STE 101A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2920
Practice Address - Country:US
Practice Address - Phone:201-894-0505
Practice Address - Fax:201-894-5593
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 380562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC54630Medicare UPIN
NJ443149Medicare ID - Type Unspecified