Provider Demographics
NPI:1427332873
Name:PETER KELT MD PC
Entity type:Organization
Organization Name:PETER KELT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KELT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-749-3149
Mailing Address - Street 1:700 HICKSVILLE RD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-3471
Mailing Address - Country:US
Mailing Address - Phone:516-576-5651
Mailing Address - Fax:516-576-5801
Practice Address - Street 1:44 SOUTH FERRY ROAD
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964-0880
Practice Address - Country:US
Practice Address - Phone:631-749-3149
Practice Address - Fax:631-749-4257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty