Healthcare Provider Details

I. General information

NPI: 1619997095
Provider Name (Legal Business Name): VIRGINIA KECK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA CHANG

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 09/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 2ND AVE
NEW YORK NY
10010-5615
US

IV. Provider business mailing address

68 S. SERVICE RD. STE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 212-975-1065
  • Fax:
Mailing address:
  • Phone: 516-945-3351
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number029346
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1644161
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: