Healthcare Provider Details

I. General information

NPI: 1962417352
Provider Name (Legal Business Name): KEUKA FAMILY PRACTICE ASSOCIATES LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7573 STATE ROUTE 54
BATH NY
14810-9504
US

IV. Provider business mailing address

7573 STATE ROUTE 54
BATH NY
14810-9504
US

V. Phone/Fax

Practice location:
  • Phone: 607-776-2247
  • Fax: 607-776-5919
Mailing address:
  • Phone: 607-776-2247
  • Fax: 607-776-5919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS W O'CONNOR
Title or Position: PARTNER
Credential: M.D.
Phone: 607-776-2247