Provider Demographics
NPI:1811973449
Name:KELEMEN, JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:KELEMEN
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 1:824 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-4950
Mailing Address - Country:US
Mailing Address - Phone:516-822-2230
Mailing Address - Fax:516-822-0163
Practice Address - Street 1:824 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4950
Practice Address - Country:US
Practice Address - Phone:516-822-2230
Practice Address - Fax:516-822-0163
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1294802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00942549Medicaid
NYAS410OtherOXFORD
NY0702646-011OtherCIGNA
NY948742OtherUNITED HEALTHCARE
NY4203368OtherAETNA
NY0064091OtherAETNA USHC
NY39A261OtherEMPIRE BLUE CROSS
NY00942549Medicaid
NY39A261OtherEMPIRE BLUE CROSS