Healthcare Provider Details

I. General information

NPI: 1639173552
Provider Name (Legal Business Name): HAROLD MOSHE KELLNER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 E MAIN ST
ELMSFORD NY
10523-3200
US

IV. Provider business mailing address

92 E MAIN ST
ELMSFORD NY
10523-3200
US

V. Phone/Fax

Practice location:
  • Phone: 914-592-7483
  • Fax: 914-592-7686
Mailing address:
  • Phone: 914-592-7483
  • Fax: 914-592-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number021930-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: