Provider Demographics
NPI:1578884573
Name:HALLER, KEITH (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:HALLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 W 59TH ST
Mailing Address - Street 2:APT #14A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1047
Mailing Address - Country:US
Mailing Address - Phone:917-749-0339
Mailing Address - Fax:
Practice Address - Street 1:515 W 59TH ST
Practice Address - Street 2:APT #14A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1047
Practice Address - Country:US
Practice Address - Phone:917-749-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program