1992714927 NPI number — DR. KEITH SILLER M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992714927 NPI number — DR. KEITH SILLER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILLER
Provider First Name:
KEITH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992714927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 NORTHERN BLVD
Provider Second Line Business Mailing Address:
STE 128
Provider Business Mailing Address City Name:
GREENVALE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11548-1221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
212-263-1485
Provider Business Mailing Address Fax Number:
212-263-7871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 NORTHERN BLVD
Provider Second Line Business Practice Location Address:
STE 128
Provider Business Practice Location Address City Name:
GREENVALE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11548-1221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-263-1485
Provider Business Practice Location Address Fax Number:
212-263-7871
Provider Enumeration Date:
08/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  77681 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X , with the licence number: 183913-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 134028827 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134028827 . This is a "1199" identifier . This identifiers is of the category "OTHER".
  • Identifier: 183913 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0260620 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134028827 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134028827 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0M0825 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134028827 . This is a "EMPIRE UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3001206 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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