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Individual

MR. SCOTT KEATLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RD, CDN

Contact information

Practice address
596 BROADWAY, STE 302, NEW YORK, NY 10012-3396
(800) 571-8276
(888) 974-0289
Mailing address
869 PARK AVE APT 2A, BROOKLYN, NY 11206-7334
(800) 571-8276
(888) 974-0289

Taxonomy

Speciality
Code
Description
License number
State
133N00000X
Nutritionist
009107
NY
133V00000X
Registered Dietitian
Primary
133VN1005X
Renal Nutrition Registered Dietitian
009107
NY
133VN1006X
Metabolic Nutrition Registered Dietitian
009107
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
009107
NYS REGISTRATION
NY
01
06090442
BLUE CROSS BLUE SHIELD
NY
01
6004111
AETNA
NY
01
75762436
CIGNA
NY
01
NU009107
HEALTHFIRST
NY
Enumeration date
06/15/2016
Last updated
01/21/2025
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