Individual
KEITH G ANCONA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 E MAIN ST, SUITE 5, SMITHTOWN, NY 11787-2900
(631) 979-6466
(631) 979-6475
Mailing address
300 E MAIN ST, SUITE 5, SMITHTOWN, NY 11787-2900
(631) 979-6466
(631) 979-6475
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
221658
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02413734
—
NY
Enumeration date
04/27/2006
Last updated
07/08/2007
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