Individual
FREDRIC RUSSELL KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
222 W 14TH ST, NEW YORK, NY 10011-7200
(212) 604-1800
(212) 604-1892
Mailing address
30 W 13TH ST, #2C, NEW YORK, NY 10011-7912
(212) 604-8026
(212) 604-7627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125401
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00520383
—
NY
Enumeration date
07/05/2006
Last updated
07/26/2010
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