Provider Demographics
NPI:1437107810
Name:EDDLEMAN, KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:EDDLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 E 98TH ST
Mailing Address - Street 2:2ND FLOOR BOX 1171
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-241-6551
Mailing Address - Fax:212-348-7438
Practice Address - Street 1:5 E 98TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-241-6551
Practice Address - Fax:212-348-7438
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177704207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY919722OtherUHC/HMO/POS/PPO/EPM/INDEM
NY0696160OtherAETNA/HMO
NY4529310OtherCIGNAHMO/PPO/POS
NYMT0001160OtherSELECTRO PRO/PPO/EPO
NY01135437Medicaid
NY4269005OtherAETNA/PPO/POS/EPO/INDEMNI
NYNP330OtherFREEDOM/OXFORD MEDICARE
NY919722OtherMSNYU HEALTH TOP TIER
NY704279OtherFIRSTHEALTH /PPO
NY919722OtherMSNYU HEALTH TOP TIER
NY919722OtherUHC/HMO/POS/PPO/EPM/INDEM