Provider Demographics
NPI:1023215225
Name:USISKIN, KEITH STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:STANLEY
Last Name:USISKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OGDEN RD
Mailing Address - Street 2:
Mailing Address - City:MENDHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07945-1811
Mailing Address - Country:US
Mailing Address - Phone:908-432-4605
Mailing Address - Fax:
Practice Address - Street 1:FAMILY HEALTH CENTER
Practice Address - Street 2:100 SOUTH STREET
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960
Practice Address - Country:US
Practice Address - Phone:973-889-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA053053207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism