Healthcare Provider Details

I. General information

NPI: 1275510521
Provider Name (Legal Business Name): GINA M. KEEP N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 NEW YORK AVE
MASSAPEQUA NY
11758-4601
US

IV. Provider business mailing address

119 NEW YORK AVE
MASSAPEQUA NY
11758-4601
US

V. Phone/Fax

Practice location:
  • Phone: 516-799-2555
  • Fax: 516-799-2595
Mailing address:
  • Phone: 516-799-2555
  • Fax: 516-799-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF333921-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: