Basic Information
| Provider Information | |||||||||
| NPI: | 1902426935 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEIFFER | ||||||||
| FirstName: | PRESTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27 LINCOLN PL APT C | ||||||||
| Address2: | |||||||||
| City: | NORTH BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 089024067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6093325553 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PLZ | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454041815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9376413000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2020 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.