Charles H. Kellner, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

25MA07375600 Issued in NJ

Practice address

1 Gustave L. Levy Place,
Box 1230
New York, NY 10029-6574

Phone

(973) 972-0037

Fax

(973) 972-9355

NPI assigned

Feb 1, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Icahn School of Medicine at Mount Sinai

  • Addiction Medicine (Psychiatry & Neurology) Physician
  • New York, NY
  • NPI 1033482518
  Medicare reassignment NPD
• New York Community Hospital of Brooklyn Inc

  • Psychiatric Hospital Unit
  • Brooklyn, NY
  • NPI 1508377334
  Medicare reassignment NPD
• Icahn School of Medicine at Mount Sinai

  • Eyewear Supplier
  • New York, NY
  • NPI 1760227466
  NPD
• New York Community Hospital of Brooklyn Inc

  • General Acute Care Hospital
  • Brooklyn, NY
  • NPI 1215030697
  NPD

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251676800000",
    "number": "1366580730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L. LEVY PLACE,",
            "address_2": "BOX 1230",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296574",
            "telephone_number": "212-659-8838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GUSTAVE L. LEVY PLACE,",
            "address_2": "BOX 1230",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100296574",
            "telephone_number": "973-972-0037",
            "fax_number": "973-972-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLNER",
        "first_name": "CHARLES",
        "middle_name": "H.",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2009-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NJ",
            "license": "25MA07375600",
            "primary": true
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "NJ",
            "license": "25MA07375600",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5651409",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Raphael Kellman, MD
• Tara Victoria Kellman, PSYD
• Tia Ann-Patrice Kellman, AGACNP-BC
• Sara Kellner-Tsulis, LMT
• Abigail Rose Kellner, NP
• Christopher Paul Kellner, M.D.
• Curtis Jay Kellner, RPH
• Jack Kellner, M.D.
• Judith Kellner, LCSW
• Ethan Kellogg, M.D.

• Psychiatry Physician in New York, NY
• Providers in New York, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2009; 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.