Provider Demographics
NPI:1093932659
Name:KEITH HOERNING DOCTORS CARE
Entity Type:Organization
Organization Name:KEITH HOERNING DOCTORS CARE
Other - Org Name:DR STEVEN BERLEY & DR KEITH HOERNING PTR DOCTORS CARE DO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOERNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-276-3600
Mailing Address - Street 1:290 EAST SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757
Mailing Address - Country:US
Mailing Address - Phone:631-226-3600
Mailing Address - Fax:631-991-7535
Practice Address - Street 1:290 EAST SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757
Practice Address - Country:US
Practice Address - Phone:631-226-3600
Practice Address - Fax:631-991-7535
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KEITH HOERNING DOCTORS CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDF4563OtherRAILROAD MEDICARE
NY02542785Medicaid