Healthcare Provider Details

I. General information

NPI: 1427332873
Provider Name (Legal Business Name): PETER KELT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 SOUTH FERRY ROAD
SHELTER ISLAND NY
11964-0880
US

IV. Provider business mailing address

700 HICKSVILLE RD SUITE 200B
BETHPAGE NY
11714-3471
US

V. Phone/Fax

Practice location:
  • Phone: 631-749-3149
  • Fax: 631-749-4257
Mailing address:
  • Phone: 516-576-5651
  • Fax: 516-576-5801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DR. PETER ANTHONY KELT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 631-749-3149