Provider Demographics
NPI:1437491164
Name:KELLER, LESTER S (DPM)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:S
Last Name:KELLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PRAIRIE COURT
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949
Mailing Address - Country:US
Mailing Address - Phone:631-874-8584
Mailing Address - Fax:
Practice Address - Street 1:300 PRAIRIE CT
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-2653
Practice Address - Country:US
Practice Address - Phone:631-874-8584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2073213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist