Provider Demographics
NPI:1518673342
Name:KEYCARE MEDICAL OF NEW JERSEY, P.C.
Entity Type:Organization
Organization Name:KEYCARE MEDICAL OF NEW JERSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT PRACTICE OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KARIL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:608-235-7970
Mailing Address - Street 1:1440 W TAYLOR ST # 227
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:331-472-7443
Mailing Address - Fax:
Practice Address - Street 1:1713 W. DIVERSEY PKWY
Practice Address - Street 2:SUITE G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:331-472-7443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty