Healthcare Provider Details

I. General information

NPI: 1851844021
Provider Name (Legal Business Name): DOUGLAS KELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 SPRINGDALE RD STE 150
CHERRY HILL NJ
08003-2763
US

IV. Provider business mailing address

1301 SPRINGDALE RD STE 150
CHERRY HILL NJ
08003-2763
US

V. Phone/Fax

Practice location:
  • Phone: 609-424-1333
  • Fax: 856-424-7384
Mailing address:
  • Phone: 609-304-7754
  • Fax: 856-424-7384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SL07179100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: