DR. DYLAN SEAN KELLOGG (NPI# 1730455767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730455767 |
| Entity Type | Individual |
| Full Name | DR. DYLAN SEAN KELLOGG |
| Credential | MD |
| Practice Address |
600 Roe Ave Elmira NY 14905-1629 |
| Mailing Address |
571 Saint Josephs Blvd 2nd Floor Elmira NY 14901-3230 |
| Practice Telephone | 6077374508 |
| Mailing Telephone | 6072712050 |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2016-10-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | 282011-1 | NY | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | D0080519 | MD | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | P28056 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 04390736 | 05 |
| Street Address |
600 ROE AVE |
| City | ELMIRA |
| State | NY |
| Zip Code | 14905-1629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184629768 | Ziya Bilen | Internal Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2005-06-20 |
| 1619583697 | Kelsey Ann Young | Physician Assistant | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-09-16 |
| 1053933499 | Branden Riggins | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-05-08 |
| 1184245664 | Bradley Steven Phelps | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1676 | 2020-05-06 |
| 1497376263 | Lucas Edward Place | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-05-02 |
| 1568083475 | John Michael Yavorski IIi | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1676 | 2020-05-01 |
| 1083235139 | Devin Craig Thompson | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-04-29 |
| 1538780887 | Alexandra Helena Sheriff | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-04-28 |
| 1801417217 | Fatima Asfia Qadri | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-04-27 |
| 1376163386 | Jaskarn Virk | Student in an Organized Health Care Education/Training Program | 600 Roe Ave, Elmira, NY 14905-1629 | 2020-04-20 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780234146 | Theron Bennett | Technician | 900 West First Street, Elmira, NY 14905 | 2019-09-18 |
| 1558893792 | Zhezheng Li | Student in an Organized Health Care Education/Training Program | 600 Roe Street, Elmira, NY 14905 | 2017-03-28 |
| 1932555885 | Mitchell Pearce | Student in an Organized Health Care Education/Training Program | 602 Ivy Street, Elmira, NY 14905 | 2016-05-10 |
| 1982974465 | Chris Cook | Registered Nurse | 110 Hendy Ave, Elmira, NY 14905 | 2011-12-30 |
| 1578795290 | Richard Grinstead | Radiology | Arnot Ogden Medical Center, 600 Roe Ave, Elmira, NY 14905 | 2009-08-13 |
| 1033343967 | Janice Elaine Jackson | Registered Nurse | 1135 Hoffman Street, Elmira, NY 14905 | 2009-05-06 |
| 1598823361 | Obrien Hearing Aid Center | Hearing Aid Equipment | 227 Hoffman St, Elmira, NY 14905 | 2006-12-05 |
| 1487712634 | Robert Gordon Lyon | Dentist | 208 Walnut Street, Elmira, NY 14905 | 2006-12-04 |
| 1215009600 | Twin Tiers Dental Pllc | Dentist | 420 West Water St, Elmira, NY 14905 | 2006-11-14 |
| 1356432348 | Womens Health Services of Elmira | Obstetrics & Gynecology | 600 Fitch St Su 102, Elmira, NY 14905 | 2006-09-27 |
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| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417967712 | Marc Immerman | Emergency Medicine | 1003 Walnut St, Elmira, NY 14901-1007 | 2006-08-09 |
| 1831742816 | Nes Medical Services of New York PC | Emergency Medicine | 555 Saint Josephs Blvd, Elmira, NY 14901-3223 | 2019-07-19 |
| 1336672492 | James L Distin | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2017-04-06 |
| 1346694593 | Marisa Look | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2016-04-13 |
| 1659758993 | Stevley Koshy | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2015-05-06 |
| 1629465208 | Nicholas Gallagher | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2015-04-21 |
| 1982096673 | Kirsten Walton | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2015-03-04 |
| 1538572847 | Timothy Beau Stokes | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905 | 2014-06-04 |
| 1699111245 | Vincent Call | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2013-05-21 |
| 1437495421 | Robert Wicelinski Jr. | Emergency Medicine | 600 Roe Ave, Elmira, NY 14905-1629 | 2012-12-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.