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General NPI Number Information
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NPI Number | 1124025473
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Entity Type | Individual
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Provider Name | TIMOTHY D KEYES PA
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Gender | Male
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 11/22/2025
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Provider Practice Location Address
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Address Line | 30 HARRISON ST STE 250
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City | JOHNSON CITY
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State | NY
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Zip | 13790-2176
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Country | US
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Telephone | 607-763-6580
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Fax |
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Provider Business Mailing Address
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Address Line | 104 UNION AVE STE 804
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City | SYRACUSE
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State | NY
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Zip | 13203-1844
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Country | US
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Telephone | 315-703-5049
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Fax | 315-703-5079
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 008055
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 008055-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 008005
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License Number State | NY
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