Basic Information
| Provider Information | |||||||||
| NPI: | 1427332873 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PETER KELT MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 HICKSVILLE RD | ||||||||
| Address2: | SUITE 200B | ||||||||
| City: | BETHPAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117143471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165765651 | ||||||||
| FaxNumber: | 5165765801 | ||||||||
| Practice Location | |||||||||
| Address1: | 44 SOUTH FERRY ROAD | ||||||||
| Address2: | |||||||||
| City: | SHELTER ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119640880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6317493149 | ||||||||
| FaxNumber: | 6317494257 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2011 | ||||||||
| LastUpdateDate: | 10/04/2011 | ||||||||
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| AuthorizedOfficialLastName: | KELT | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | ANTHONY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6317493149 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.