Provider Demographics
NPI:1306163332
Name:KEANE, CHRISTOPHER G (FNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:G
Last Name:KEANE
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 ALYSIA CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-2017
Mailing Address - Country:US
Mailing Address - Phone:718-227-7638
Mailing Address - Fax:
Practice Address - Street 1:51 ALYSIA CT
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-2017
Practice Address - Country:US
Practice Address - Phone:718-227-7638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMK0492784OtherDEA#