Provider Demographics
NPI:1225098577
Name:KEENEY, KRISTINE M (MD,)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:M
Last Name:KEENEY
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BROAD RD
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2265
Mailing Address - Country:US
Mailing Address - Phone:315-492-5660
Mailing Address - Fax:315-492-3571
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:SUITE 1D
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-5660
Practice Address - Fax:315-492-3571
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY232864208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02733466Medicaid
NYRA9500Medicare ID - Type Unspecified
NY02733466Medicaid