| Organization Name: | PETER KELT MD PC |
| NPI Number: | 1427332873 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PETER ANTHONY KELT (PRESIDENT) |
| Mailing Address: | 44 South Ferry Road Shelter Island |
| State: | NY US |
| Postal Code: | 119640880 |
| Phone Number: | 6317493149 |
| Fax Number: | 6317494257 |
| NPI Enumeration Date: | 10/04/2011 |
| NPI Last Update Date: | 10/04/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |