Provider Demographics
NPI:1689962276
Name:KELLER-DUEMIG, ELAINE (CNM)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:
Last Name:KELLER-DUEMIG
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MS
Other - First Name:ELAINE
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:285 WEST END AVENUE
Mailing Address - Street 2:SUITE Y2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5329
Mailing Address - Country:US
Mailing Address - Phone:212-531-2229
Mailing Address - Fax:914-462-4409
Practice Address - Street 1:285 W END AVE
Practice Address - Street 2:SUITE Y2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2504
Practice Address - Country:US
Practice Address - Phone:212-531-2229
Practice Address - Fax:914-462-4409
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-16
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00049601367A00000X
NJ25ME00049600367A00000X
NY001421367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife