Provider Demographics
NPI:1699786632
Name:KELTZ, THEODORE N (MD)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:N
Last Name:KELTZ
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 1:150 LOCKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801
Mailing Address - Country:US
Mailing Address - Phone:914-633-7870
Mailing Address - Fax:914-633-7626
Practice Address - Street 1:150 LOCKWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801
Practice Address - Country:US
Practice Address - Phone:914-633-7870
Practice Address - Fax:914-633-7626
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147709207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0101299OtherGHI
010147709NYOtherANTHEM
538595OtherAETNA HMO
01227053OtherUNITED
4123687OtherAETNA
4604127024OtherCIGNA
WS338OtherOXFORD
18941OtherHHP
NY01163946Medicaid
060012979OtherRR MEDICARE
27481POtherHIP
27481POtherHIP
4123687OtherAETNA