Provider Demographics
NPI:1265681340
Name:KEITH, DAVID ETHAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ETHAN
Last Name:KEITH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 VAN DER DONCK ST
Mailing Address - Street 2:APT 113.
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-7049
Mailing Address - Country:US
Mailing Address - Phone:845-661-2071
Mailing Address - Fax:
Practice Address - Street 1:FIRST AVE. AT 16TH STREET
Practice Address - Street 2:BETH ISRAEL MED. CTR., DEPT. SURG.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-420-5603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001058363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical