Healthcare Provider Details

I. General information

NPI: 1548197973
Provider Name (Legal Business Name): COREY KEANE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 N BUFFALO ST
ORCHARD PARK NY
14127-1934
US

IV. Provider business mailing address

3 SOLDIER WOOD CIR
ORCHARD PARK NY
14127-4855
US

V. Phone/Fax

Practice location:
  • Phone: 716-662-8510
  • Fax:
Mailing address:
  • Phone: 716-462-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: