Provider Demographics
NPI:1114667508
Name:JONES, KEITH ANTHONY
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:ANTHONY
Last Name:JONES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 STORI RD
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-7223
Mailing Address - Country:US
Mailing Address - Phone:848-457-6458
Mailing Address - Fax:
Practice Address - Street 1:7 STORI RD
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-7223
Practice Address - Country:US
Practice Address - Phone:845-764-5840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver