Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 027080 | NY |
NPI | 1013359595 |
---|---|
Provider Name | Kristy Keller |
First Address | Shirley, NY 11967-1301 |
Second Address | Shirley, NY 11967-1301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2013 |
Last Update Date | 24/07/2013 |