Provider Demographics
NPI:1841653615
Name:DR. FREDERICK A. KELNER, P.C.
Entity type:Organization
Organization Name:DR. FREDERICK A. KELNER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KELNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD,
Authorized Official - Phone:610-733-9304
Mailing Address - Street 1:10 FOX RUN LN
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-1004
Mailing Address - Country:US
Mailing Address - Phone:610-733-9304
Mailing Address - Fax:
Practice Address - Street 1:10 FOX RUN LN
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-1004
Practice Address - Country:US
Practice Address - Phone:610-733-9304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-000371-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101616397Medicaid
PA030325Medicare PIN