Healthcare Provider Details

I. General information

NPI: 1760601413
Provider Name (Legal Business Name): MATTHEW G KESCHNER DC, CCSP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PARK AVE STE 1-C
NEW YORK NY
10016-2507
US

IV. Provider business mailing address

71 PARK AVE STE 1-C
NEW YORK NY
10016-2507
US

V. Phone/Fax

Practice location:
  • Phone: 212-683-4740
  • Fax: 212-213-9495
Mailing address:
  • Phone: 212-683-4740
  • Fax: 212-213-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX010185
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: