Provider Demographics
NPI:1033145990
Name:FREER, KEITH R (BOCO)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:R
Last Name:FREER
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 MAIN STREET
Mailing Address - Street 2:APARTMENT 336
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10044
Mailing Address - Country:US
Mailing Address - Phone:917-685-8171
Mailing Address - Fax:
Practice Address - Street 1:949 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-4305
Practice Address - Country:US
Practice Address - Phone:718-860-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC22314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5594260001Medicare NSC