=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194884627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HAROLD M KELLNER DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 92 E MAIN ST
-----------------------------------------------------
City | ELMSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10523-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-592-7483
-----------------------------------------------------
Fax | 914-592-7686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 92 E MAIN ST
-----------------------------------------------------
City | ELMSFORD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10523-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-592-7483
-----------------------------------------------------
Fax | 914-592-7686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. HAROLD MOSHE KELLNER
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 914-592-7483
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 0-21930-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------