Healthcare Provider Details

I. General information

NPI: 1235804584
Provider Name (Legal Business Name): RUTH LOUISA KEELING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CROTTY LN UPPR LEVEL
NEW WINDSOR NY
12553-4778
US

IV. Provider business mailing address

660 WHITE PLAINS ROAD - ENTA FOURTH FLOOR
TARRYTOWN NY
10591-6802
US

V. Phone/Fax

Practice location:
  • Phone: 845-562-0760
  • Fax:
Mailing address:
  • Phone: 914-984-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: