Healthcare Provider Details

I. General information

NPI: 1992714927
Provider Name (Legal Business Name): KEITH SILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 NORTHERN BLVD STE 128
GREENVALE NY
11548-1221
US

IV. Provider business mailing address

2200 NORTHERN BLVD STE 128
GREENVALE NY
11548-1221
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-1485
  • Fax: 212-263-7871
Mailing address:
  • Phone: 212-263-1485
  • Fax: 212-263-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number77681
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number183913-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: