MEDICARE: KEANE I CORT

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	163W00000X	Registered Nurse	666033	NY

General Provider Information

NPI Number	:	1417898065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEANE I CORT

Provider Business Mailing Address
First Line	:	15 FILLMORE DR
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-3704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 FILLMORE DR
Second Line	:
City	:	STONY POINT
State	:	NY
Zip	:	10980-3704
Country	:	US
Telephone Number	:	917-626-0381
Fax Number	:

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

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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Directions to “ KEANE I CORT ” Practice Location

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