Provider Demographics
NPI:1770638868
Name:KERESZTES, ROGER S (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:S
Last Name:KERESZTES
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 1:3 EDMUND PELLEGRINO RD
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-9447
Mailing Address - Country:US
Mailing Address - Phone:631-638-1000
Mailing Address - Fax:631-444-7530
Practice Address - Street 1:3 EDMUND PELLEGRINO RD
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-9447
Practice Address - Country:US
Practice Address - Phone:631-638-1000
Practice Address - Fax:631-444-7530
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180051207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56K881Medicare ID - Type Unspecified