Provider Demographics
NPI:1588623631
Name:SEIDENBERG, KEITH B (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:B
Last Name:SEIDENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07432-1468
Mailing Address - Country:US
Mailing Address - Phone:201-447-9101
Mailing Address - Fax:201-447-9103
Practice Address - Street 1:600 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1468
Practice Address - Country:US
Practice Address - Phone:201-447-9101
Practice Address - Fax:201-447-9103
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05916500207W00000X
NY1860001-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ532736Medicare ID - Type Unspecified
NJF90115Medicare UPIN