Healthcare Provider Details

I. General information

NPI: 1346426772
Provider Name (Legal Business Name): KEITH BUSHEY DENISON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST A-1015
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

575 LEXINGTON AVE
NEW YORK NY
10022-6102
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-4887
  • Fax: 212-746-8108
Mailing address:
  • Phone: 212-746-2962
  • Fax: 212-746-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number532876
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number064618-21
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number064618-23
License Number StateNH
# 4
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number532876
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: