Healthcare Provider Details

I. General information

NPI: 1770554206
Provider Name (Legal Business Name): LYNN M KEPPEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 64 ST SUITE 402
NEW YORK CITY NY
10021
US

IV. Provider business mailing address

205 E 64 ST SUITE 402
NEW YORK CITY NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-4553
  • Fax: 212-486-8334
Mailing address:
  • Phone: 212-759-4553
  • Fax: 212-486-8334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009505
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: