Healthcare Provider Details

I. General information

NPI: 1043296833
Provider Name (Legal Business Name): BRENDAN J. KEYS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4295 HEMPSTEAD TPKE
BETHPAGE NY
11714-5713
US

IV. Provider business mailing address

PO BOX 826186
PHILADELPHIA PA
19182-6186
US

V. Phone/Fax

Practice location:
  • Phone: 516-579-6000
  • Fax:
Mailing address:
  • Phone: 866-898-7142
  • Fax: 770-237-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF334247-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: