Provider Demographics
NPI:1073862322
Name:KELLER, ROBERT
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:KELLER
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 1:851 NJ-73 NORTH
Mailing Address - Street 2:SUITE G
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-2145
Mailing Address - Country:US
Mailing Address - Phone:856-751-3444
Mailing Address - Fax:
Practice Address - Street 1:851 NJ-73 NORTH
Practice Address - Street 2:SUITE G
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2145
Practice Address - Country:US
Practice Address - Phone:856-751-3444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-31
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00005100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223542869OtherEIN