Individual
KEITH DENIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
20822 15TH DR, BAYSIDE, NY 11360-1135
(631) 383-3137
Mailing address
20822 15TH DR, BAYSIDE, NY 11360-1135
(631) 383-3137
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
09/28/2015
Last updated
09/28/2015
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