Individual
JACK KELLNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 W 95TH ST, NEW YORK, NY 10025-6331
(917) 331-1459
Mailing address
215 W 95TH ST, NEW YORK, NY 10025-6331
Taxonomy
Speciality
Code
Description
License number
State
2083P0901X
Public Health & General Preventive Medicine Physician
Primary
184865
NY
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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