Provider Demographics
NPI:1962498907
Name:KAELL, ALAN T (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
Last Name:KAELL
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 1:315 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2817
Mailing Address - Country:US
Mailing Address - Phone:631-360-3796
Mailing Address - Fax:631-360-1546
Practice Address - Street 1:315 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2817
Practice Address - Country:US
Practice Address - Phone:631-360-7778
Practice Address - Fax:631-979-1609
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY139331174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01696395Medicaid
NY01696395Medicaid
NY05D701Medicare ID - Type Unspecified