Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 188631 | NY |
N | 207YP0228X | Pediatric Otolaryngology | 188631 | NY |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 188631 | NY |
NPI | 1962459875 |
---|---|
Provider Name | Jeffrey L Keller |
First Address | Mount Kisco, NY 10549-3446 |
Second Address | Mount Kisco, NY 10549-3412 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2006 |
Last Update Date | 11/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01655114 | (05) | NY |
0667910001 | DME (01) | NY |
P00421812 | MEDICARE RAILROAD (01) | NY |