Healthcare Provider Details

I. General information

NPI: 1093841058
Provider Name (Legal Business Name): KEITH J DEGI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 W 17TH ST 7TH FLOOR
NEW YORK NY
10011-5325
US

IV. Provider business mailing address

PO BOX 95000-2240
PHILADELPHIA PA
19195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-6500
  • Fax: 212-523-8555
Mailing address:
  • Phone: 212-523-6500
  • Fax: 212-523-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number211218
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number211218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: