Provider Demographics
NPI:1407022015
Name:KETNER, DAVID SCOTT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SCOTT
Last Name:KETNER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1276 FULTON AVE STE 3D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-3402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1276 FULTON AVE RM 208
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-3402
Practice Address - Country:US
Practice Address - Phone:171-890-1891
Practice Address - Fax:718-901-8918
Is Sole Proprietor?:No
Enumeration Date:2008-05-03
Last Update Date:2022-03-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY254818207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist