Individual
KEITH ADAM KRUPA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
19 LAURITA GATE, PORT JEFFERSON, NY 11777-2113
(631) 413-1717
Mailing address
200 WIRELESS BLVD, HAUPPAUGE, NY 11788-3974
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
893109
NY
Other
Enumeration date
09/08/2020
Last updated
07/06/2023
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