MEDICARE: MR. CHRISTOPHER KEIBEL PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	008649-1	NY

General Provider Information

NPI Number	:	1053746743
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER KEIBEL PTA

Provider Business Mailing Address
First Line	:	80 MAPLE AVE
Second Line	:
City	:	BELLPORT
State	:	NY
Zip	:	11713-2018
Country	:	US
Telephone Number	:	631-428-0368
Fax Number	:

Provider Business Practice Location Address
First Line	:	1133 MONTAUK HWY
Second Line	:
City	:	MASTIC
State	:	NY
Zip	:	11950-2918
Country	:	US
Telephone Number	:	631-399-0007
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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Directions to “ MR. CHRISTOPHER KEIBEL PTA” Practice Location

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