Individual
DR. KEITH ROBERT GONSOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
627 BROADWAY, SUITE 200, MASSAPEQUA, NY 11758-5031
(516) 799-6001
(516) 799-4464
Mailing address
627 BROADWAY, SUITE 200, MASSAPEQUA, NY 11758-5031
(516) 799-6001
(516) 799-4464
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
010346
NY
Other
Enumeration date
11/29/2006
Last updated
07/09/2007
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