Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MA035497 | NJ |
Y | 111NI0900X | Internist | MA035497 | NJ |
N | 207RG0300X | Geriatric Medicine | MA035497 | NJ |
NPI | 1154394286 |
---|---|
Provider Name | Dr. Richard Kelter |
First Address | Morganville, NJ 07751-1176 |
Second Address | Morganville, NJ 07751-1176 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2006 |
Last Update Date | 21/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0674206 | (05) | NJ |
31D0114041 | CLIA (01) | NJ |
C54742 | (02) | NJ |