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Individual

MRS. GINA ANGEL KEATLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MBA, CDN

Contact information

Practice address
596 BROADWAY, SUITE 302, NEW YORK, NY 10012-3396
(800) 571-8276
(888) 974-0289
Mailing address
173 HOPKINS ST APT 3L, BROOKLYN, NY 11206-5021
(800) 571-8276
(888) 974-0289

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
007594
NY
133V00000X
Registered Dietitian
Primary
007594
NY
133VN1005X
Renal Nutrition Registered Dietitian
007594
NY
133VN1006X
Metabolic Nutrition Registered Dietitian
007594
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000358830304
UNITED HEALTHCARE
01
003588303001
UNITED HEALTHCARE NY COMMUNITY
01
01901192
HEALTHPLUS AMERIGROUP
01
126DB3
BLUE CROSS BLUE SHIELD
01
2305722
CIGNA
01
3343362
GHI
01
9388910
AETNA
01
NU007594-B85
HEALTHFIRST
NY
01
P4751979
OXFORD
01
PH56000
ELDERPLAN
01
SEIU147289
1199SEIU
Enumeration date
10/20/2012
Last updated
07/10/2020
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