Healthcare Provider Details

I. General information

NPI: 1326710310
Provider Name (Legal Business Name): MARYROSE MAURO KEENAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYROSE MAURO

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S MANNING BLVD STE 220
ALBANY NY
12208-3909
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-6418
  • Fax: 518-525-5016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number027636
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027636
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: