Basic Information
| Provider Information | |||||||||
| NPI: | 1437107810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EDDLEMAN | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
| Address2: | 2ND FLOOR BOX 1171 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122416551 | ||||||||
| FaxNumber: | 2123487438 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 E 98TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100296501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122416551 | ||||||||
| FaxNumber: | 2123487438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2006 | ||||||||
| LastUpdateDate: | 12/07/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 177704 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 919722 | 01 | NY | UHC/HMO/POS/PPO/EPM/INDEM | OTHER | 0696160 | 01 | NY | AETNA/HMO | OTHER | 4529310 | 01 | NY | CIGNAHMO/PPO/POS | OTHER | MT0001160 | 01 | NY | SELECTRO PRO/PPO/EPO | OTHER | 01135437 | 05 | NY | MEDICAID | 4269005 | 01 | NY | AETNA/PPO/POS/EPO/INDEMNI | OTHER | NP330 | 01 | NY | FREEDOM/OXFORD MEDICARE | OTHER | 919722 | 01 | NY | MSNYU HEALTH TOP TIER | OTHER | 704279 | 01 | NY | FIRSTHEALTH /PPO | OTHER |