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

Table of content: DR. KEITH SILLER M.D. (NPI 1992714927)

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:
02/07/2017
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:  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: 0260620 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • 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: 134028827 . This is a "EMPIRE UNITED" 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 "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 183913 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3001206 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 134028827 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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