Provider Demographics
NPI:1598764946
Name:KELLER, SETH I (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:I
Last Name:KELLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1421 3RD AVE
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1899
Mailing Address - Country:US
Mailing Address - Phone:212-390-1020
Mailing Address - Fax:800-395-4183
Practice Address - Street 1:1421 3RD AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1899
Practice Address - Country:US
Practice Address - Phone:212-390-1020
Practice Address - Fax:800-395-4183
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY210529207RC0001X, 207RC0001X, 207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02591555Medicaid
NY02591555Medicaid
I13565Medicare UPIN