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General NPI Number Information
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NPI Number | 1467419945
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Entity Type | Individual
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Provider Name | KEYAN MA MD
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Gender | Male
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 115 E 61ST ST 7E
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City | NEW YORK
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State | NY
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Zip | 10021-8183
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Country | US
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Telephone | 212-872-1745
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Fax | 212-872-1747
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Provider Business Mailing Address
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Address Line | 41 ROBERT CIR
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City | SYOSSET
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State | NY
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Zip | 11791-3829
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Country | US
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Telephone | 516-558-7886
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 226971
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License Number State | NY
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