Active NPI
Randall Lauren Keller, PH.D.
- Psychologist
- Forest Hills, NY
National Provider Identifier
1407879281
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 013488
- Practice address
- 11021 73Rd Rd Apt 1J
Forest Hills, NY 11375-6369 - Phone
- (347) 645-2919
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 013488 | NY | Primary |
Addresses
Primary practice location
11021 73Rd Rd Apt 1J
Forest Hills, NY 11375-6369
Mailing address
8510 34TH Ave
Apt. 320
Jackson Heights, NY 11372-3244
Phone (347) 645-2919
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02165057 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181214001895 | FL | Practitioner - Psychologist Billing Independently | 8426081563 | Practice locations: Wilton Manors, FL |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013488 | NY | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208822400000",
"number": "1407879281",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8510 34TH AVE",
"address_2": "APT. 320",
"city": "JACKSON HEIGHTS",
"state": "NY",
"postal_code": "113723244",
"telephone_number": "347-645-2919",
"fax_number": "718-334-5082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11021 73RD RD APT 1J",
"city": "FOREST HILLS",
"state": "NY",
"postal_code": "113756369",
"telephone_number": "347-645-2919"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLER",
"first_name": "RANDALL",
"middle_name": "LAUREN",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2008-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NY",
"license": "013488",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "02165057",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Hills, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.