Provider Demographics
NPI:1093815920
Name:KESCHNER, MITCHELL TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:TODD
Last Name:KESCHNER
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 1:651 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803
Mailing Address - Country:US
Mailing Address - Phone:516-681-8822
Mailing Address - Fax:516-681-3332
Practice Address - Street 1:651 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:516-681-8822
Practice Address - Fax:516-681-3332
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215573207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WX0711Medicare ID - Type Unspecified
I14124Medicare UPIN