Individual provider Active NPI

Victor Pelumi Kekere, MD

  • Psychiatry Physician
  • Glen Oaks, NY
National Provider Identifier
1003480120
Registry record updated Apr 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
330755 Issued in NY
Practice address
7559 263Rd St
Glen Oaks, NY 11004-1150
Phone
(718) 470-8100
NPI assigned
May 13, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 24, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatry Physician 2084P0800X 330755 NY Primary

Addresses

Primary practice location

7559 263Rd St
Glen Oaks, NY 11004-1150

Mailing address

7559 263Rd St
Glen Oaks, NY 11004-1100
Phone (718) 470-8100

Other practice location 1

1545 Atlantic Ave
Brooklyn, NY 11213-1122
Phone (718) 613-4334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250512001701 NY Practitioner - Psychiatry 6305373127 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
The Long Island Home CurrentSince Jul 1, 2025 Accepting new patients
The Long Island Home CurrentSince Jul 1, 2025 Accepting new patients

Locations

400 Sunrise Hwy
Amityville, NY 11701
Phone (631) 264-4000

1111 Marcus Ave
Ste M04
New Hyde Park, NY 11042
Phone (585) 736-3650

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1003480120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7559 263RD ST",
            "city": "GLEN OAKS",
            "state": "NY",
            "postal_code": "110041100",
            "telephone_number": "718-470-8100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7559 263RD ST",
            "city": "GLEN OAKS",
            "state": "NY",
            "postal_code": "110041150",
            "telephone_number": "718-470-8100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1545 Atlantic Ave",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112131122",
            "country_code": "US",
            "telephone_number": "718-613-4334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEKERE",
        "first_name": "VICTOR",
        "middle_name": "PELUMI",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-13",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "330755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Oaks, NY

Sources for this page

Verify at the official NPI Registry.