Provider Demographics
NPI:1679900302
Name:JULIE M KELLER, MD, LLC
Entity type:Organization
Organization Name:JULIE M KELLER, MD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-373-3638
Mailing Address - Street 1:113 W ESSEX ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MAYWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07607-1020
Mailing Address - Country:US
Mailing Address - Phone:201-226-0145
Mailing Address - Fax:201-226-0147
Practice Address - Street 1:113 W ESSEX ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1020
Practice Address - Country:US
Practice Address - Phone:201-226-0145
Practice Address - Fax:201-226-0147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08801100207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7338860001OtherMEDICARE DME PTAN