Healthcare Provider Details

I. General information

NPI: 1053675207
Provider Name (Legal Business Name): ITAY KESHET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 STOCKHOLM ST
BROOKLYN NY
11237-4194
US

IV. Provider business mailing address

71 SCHOLES ST APT 4B
BROOKLYN NY
11206-1847
US

V. Phone/Fax

Practice location:
  • Phone: 347-286-8169
  • Fax: 440-970-1646
Mailing address:
  • Phone: 347-286-8169
  • Fax: 440-970-1646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberA143024
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number2020-03371
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME-145832
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number285120
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number76176
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number68643
License Number StateMT
# 7
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number65316
License Number StateMN
# 8
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberMD46055
License Number StateIA
# 9
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number70763
License Number StateWI
# 10
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35.134980
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: