Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 134726 | NY |
NPI | 1528068954 |
---|---|
Provider Name | Dr. Marshall J Keilson |
First Address | Brooklyn, NY 11230-7393 |
Second Address | Brooklyn, NY 11230-7393 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 23/01/2014 |