Provider Demographics
NPI:1891871265
Name:WERNER, KEITH
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:WERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 ORADELL AVE
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-2033
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:831 ORADELL AVE
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-2033
Practice Address - Country:US
Practice Address - Phone:201-262-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC156200111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJX9H93Medicare UPIN
NJ938107Medicare UPIN
NJ1K9642Medicare UPIN
NJ0857395Medicare UPIN
NJP1275504Medicare UPIN
NJ522149117001Medicare UPIN
NJWE450839Medicare ID - Type Unspecified
NJ2020447Medicare UPIN