Healthcare Provider Details

I. General information

NPI: 1598764946
Provider Name (Legal Business Name): SETH I. KELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 3RD AVE 5TH FLOOR
NEW YORK NY
10028-1899
US

IV. Provider business mailing address

1421 3RD AVE 5TH FLOOR
NEW YORK NY
10028-1899
US

V. Phone/Fax

Practice location:
  • Phone: 212-390-1020
  • Fax: 800-395-4183
Mailing address:
  • Phone: 212-390-1020
  • Fax: 800-395-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number210529
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: