Healthcare Provider Details

I. General information

NPI: 1154394286
Provider Name (Legal Business Name): RICHARD KELTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STONY HILL DR
MORGANVILLE NJ
07751-1176
US

IV. Provider business mailing address

15 STONY HILL DR
MORGANVILLE NJ
07751-1176
US

V. Phone/Fax

Practice location:
  • Phone: 732-580-9248
  • Fax: 732-536-0248
Mailing address:
  • Phone: 732-580-9248
  • Fax: 732-536-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA035497
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMA035497
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: