Individual
DR. ETHAN KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1901 1ST AVE, NEW YORK, NY 10029-7494
(212) 423-6262
Mailing address
1677 LEXINGTON AVE APT 4E, NEW YORK, NY 10029-4666
(585) 905-1974
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
299407
NY
Other
Enumeration date
07/05/2016
Last updated
08/07/2019
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