Keith Robert Brunckhorst, M.D.

Primary specialty

SpecialistTaxonomy code 174400000X

License

137444 Issued in NY

Practice address

157 E 72ND St
New York, NY 10021-4331

Phone

(212) 583-2858

Fax

(212) 988-8408

NPI assigned

Jan 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• North Shore Hematology Oncology Associates PC

  • Specialist
  • Port Jefferson Station, NY
  • NPI 1396794574
  Medicare reassignment NPD

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1053381186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "157 E 72ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214331",
            "telephone_number": "212-583-2858",
            "fax_number": "212-988-8408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 E 72ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214331",
            "telephone_number": "212-583-2858",
            "fax_number": "212-988-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNCKHORST",
        "first_name": "KEITH",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-23",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NY",
            "license": "137444",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "3C5522",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4322245",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P406448",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corrinne L Brumit, PNP
• Brummer Surgical Podiatry PC
• John Joseph Brummer, DPM
• Natalie Brumwell
• Carla Nicole Brun, LMSW
• Desmond Brundidge
• Kaitlyn D. Bruneau, LCSW
• Rebecca Marie Brunelle
• Diane Reformina Brunelli, NP
• Andrea Brunetti

• Specialist in New York, NY
• Providers in New York, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.