Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 044565 | NY |
NPI | 1972505493 |
---|---|
Provider Name | Dr. Robert Douglas Kelsch |
First Address | New Hyde Park, NY 11040-1433 |
Second Address | New Hyde Park, NY 11040-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2005 |
Last Update Date | 08/07/2007 |