MEDICARE: JUDITH M. KEILSON

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	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1376423632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH M. KEILSON

Provider Business Mailing Address
First Line	:	576 CEDAR HILL RD
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-5403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-1534
Country	:	US
Telephone Number	:	646-656-1553
Fax Number	:

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

Provider Enumeration Date	:	09/05/2025
Last Update Date	:	10/16/2025

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Directions to “ JUDITH M. KEILSON ” Practice Location

Language	Start Address	Practice Location

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