Healthcare Provider Details

I. General information

NPI: 1689962276
Provider Name (Legal Business Name): ELAINE MICHELLE KELLER-DUEMIG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELAINE MICHELLE KELLER CNM

II. Dates (important events)

Enumeration Date: 07/16/2011
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 W END AVE SUITE Y2
NEW YORK NY
10023-2504
US

IV. Provider business mailing address

11 RIVERSIDE DR STE Y2
NEW YORK NY
10023-2592
US

V. Phone/Fax

Practice location:
  • Phone: 212-531-2229
  • Fax: 914-462-4409
Mailing address:
  • Phone: 212-531-2229
  • Fax: 914-462-4409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001421
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00049600
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00049601
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: