MEDICARE: GINA M. KEEP N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	F333921-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0145G1	OTHER	NY	BLUECROSS BLUESHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275510521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA M. KEEP N.P.

Provider Business Mailing Address
First Line	:	119 NEW YORK AVE
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-4601
Country	:	US
Telephone Number	:	516-799-2555
Fax Number	:	516-799-2595

Provider Business Practice Location Address
First Line	:	119 NEW YORK AVE
Second Line	:
City	:	MASSAPEQUA
State	:	NY
Zip	:	11758-4601
Country	:	US
Telephone Number	:	516-799-2555
Fax Number	:	516-799-2595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	06/02/2022

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