Provider Demographics
NPI:1972336790
Name:KEOGLER, DANA ROSE
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:ROSE
Last Name:KEOGLER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GREENHILLS RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3906
Mailing Address - Country:US
Mailing Address - Phone:631-707-5675
Mailing Address - Fax:
Practice Address - Street 1:30 GREENHILLS RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3906
Practice Address - Country:US
Practice Address - Phone:631-707-5675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program