MEDICARE: ITAY KESHET MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A2900X	Neurocritical Care Physician	A143024	CA
2	2084A2900X	Neurocritical Care Physician	2020-03371	NC
3	2084A2900X	Neurocritical Care Physician	ME-145832	FL
4	2084A2900X	Neurocritical Care Physician	285120	NY
5	2084N0400X	Neurology Physician	76176	TN
6	2084N0400X	Neurology Physician	68643	MT
7	2084A2900X	Neurocritical Care Physician	65316	MN
8	2084A2900X	Neurocritical Care Physician	MD46055	IA
9	2084N0400X	Neurology Physician	70763	WI
10	2084N0400X	Neurology Physician	35.134980	OH

General Provider Information

NPI Number	:	1053675207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITAY KESHET MD

Provider Business Mailing Address
First Line	:	71 SCHOLES ST APT 4B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11206-1847
Country	:	US
Telephone Number	:	347-286-8169
Fax Number	:	440-970-1646

Provider Business Practice Location Address
First Line	:	371 STOCKHOLM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4194
Country	:	US
Telephone Number	:	347-286-8169
Fax Number	:	440-970-1646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/02/2012
Last Update Date	:	05/30/2026

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