Healthcare Provider Details

I. General information

NPI: 1336502871
Provider Name (Legal Business Name): EFRAIM JUNIOR KEISARI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANETTO HILL RD STE 209
PLAINVIEW NY
11803-1311
US

IV. Provider business mailing address

338 JERICHO TPKE # 204
SYOSSET NY
11791-4507
US

V. Phone/Fax

Practice location:
  • Phone: 212-287-5888
  • Fax: 918-205-8628
Mailing address:
  • Phone: 212-287-5888
  • Fax: 918-205-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME137782
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number310653
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: