Provider Demographics
NPI:1306037940
Name:DALMACY, KESLER
Entity Type:Individual
Prefix:
First Name:KESLER
Middle Name:
Last Name:DALMACY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1671 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3366
Mailing Address - Country:US
Mailing Address - Phone:718-434-5345
Mailing Address - Fax:718-434-5567
Practice Address - Street 1:1671 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3366
Practice Address - Country:US
Practice Address - Phone:718-434-5345
Practice Address - Fax:718-434-5567
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155589207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00864764Medicaid
NYA62612Medicare PIN