Michael P Ketzak, NP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

F402042-1 Issued in NY

Practice address

425 Robinson St
Binghamton, NY 13904-1735

Phone

(607) 797-0680

Fax

(607) 797-4315

NPI assigned

Jul 19, 2016

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Greater Binghamton Health Center

  • Psychiatric Hospital
  • Binghamton, NY
  • NPI 1043510605
  NPD (past)

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

{
    "created_epoch": "1468886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655856000000",
    "number": "1356794903",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 ROBINSON ST",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139041735",
            "telephone_number": "607-797-0680",
            "fax_number": "607-797-4315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 ROBINSON ST",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139041735",
            "telephone_number": "607-797-0680",
            "fax_number": "607-797-4315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KETZAK",
        "first_name": "MICHAEL",
        "middle_name": "P",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-19",
        "last_updated": "2022-06-22",
        "certification_date": "2022-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NY",
            "license": "F402042-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Kerila
• Cheryl B Kerr, MD
• Douglas Robert Kerr, MD
• Lawrence Kerr, MD
• Heather Leigh Kessler, LCSW
• Kimberly Anne Keuter, CSW
• Maria Khalid
• Abdul Basit Khan, MD
• Afaque Hassan Khan
• Akbar A. Khan, M.D.

• Psychiatric/Mental Health Nurse Practitioner in Binghamton, NY
• Providers in Binghamton, NY by specialty
• Psychiatric/Mental Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2022; 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.