Provider Demographics
NPI:1275510521
Name:KEEP, GINA M (NP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:KEEP
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-4601
Mailing Address - Country:US
Mailing Address - Phone:516-799-2555
Mailing Address - Fax:516-799-2595
Practice Address - Street 1:119 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4601
Practice Address - Country:US
Practice Address - Phone:516-799-2555
Practice Address - Fax:516-799-2595
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333921-1363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0145G1OtherBLUECROSS BLUESHIELD
NY02433750Medicaid
NY02433750Medicaid
Q09678Medicare UPIN