Provider Demographics
NPI:1093841058
Name:DEGI, KEITH J (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:DEGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 95000-2240
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:212-523-6500
Mailing Address - Fax:212-523-8555
Practice Address - Street 1:230 W 17TH ST
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-5325
Practice Address - Country:US
Practice Address - Phone:212-523-6500
Practice Address - Fax:212-523-8555
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2112182084A0401X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400045011OtherMEDICARE PTAN
NY02267307Medicaid
NYD29261Medicare UPIN
NY273BKIMedicare ID - Type Unspecified