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Organization
KEITH R. BRUNCKHORST M.D. P.C.
Active
Organization
KEITH R. BRUNCKHORST M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH R BRUNCKHORST M.D (PRESIDENT)
(212) 583-2858
Entity
Organization
Contact information
Practice address
110 E 59TH ST, SUITE 9B, NEW YORK, NY 10022-1304
(212) 583-2858
(212) 407-3909
Mailing address
110 E 59TH ST, SUITE 9B, NEW YORK, NY 10022-1304
(212) 583-2858
(212) 407-3909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
137444
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3C5522
HEALTHNET
NY
01
—
4322245
AETNA
NY
01
—
6277621
CIGNA
NY
01
—
P406448
OXFORD
NY
Enumeration date
05/18/2006
Last updated
08/22/2020
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