Provider Demographics
NPI:1386014793
Name:DENIS, KEITH (PA-C)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:DENIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20822 15TH DR
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1135
Mailing Address - Country:US
Mailing Address - Phone:631-383-3137
Mailing Address - Fax:
Practice Address - Street 1:20822 15TH DR
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1135
Practice Address - Country:US
Practice Address - Phone:631-383-3137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical