Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 25MA04216900 | NJ |
N | 111NI0900X | Internist | 25MA04216900 | NJ |
Y | 207RC0000X | Internist - Cardiovascular Disease | 25MA04216900 | NJ |
NPI | 1013967520 |
---|---|
Provider Name | Dr. Malvin S Keller |
First Address | Edison, NJ 08837-3266 |
Second Address | Edison, NJ 08837-3266 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 09/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0330701 | (05) | NJ |