Individual
DR. LYDIA NICOLE KEISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
33 PLYMOUTH ST, SUITE 108, MONTCLAIR, NJ 07042-2677
(973) 744-6440
Mailing address
33 PLYMOUTH ST, SUITE 108, MONTCLAIR, NJ 07042-2677
(973) 744-6440
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
25MA08706800
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720367832
GROUP NPI
NJ
01
—
271890426
TAX ID
NJ
Enumeration date
02/24/2010
Last updated
09/13/2011
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