Provider Demographics
NPI:1467419945
Name:MA, KEYAN (MD)
Entity Type:Individual
Prefix:MR
First Name:KEYAN
Middle Name:
Last Name:MA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 ROBERT CIR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3829
Mailing Address - Country:US
Mailing Address - Phone:516-558-7886
Mailing Address - Fax:
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:7E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8183
Practice Address - Country:US
Practice Address - Phone:212-872-1745
Practice Address - Fax:212-872-1747
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226971208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02363748Medicaid
NY226971-0WOtherWORKER'S COMPENSATION
NY228517OtherUNITEDHEALTHCARE
NY2799480OtherGHI
NY5C4574OtherHEALTHNET
NY9212239004OtherCIGNA PPO
NYP3463235OtherOXFORD
NY10742714OtherCIGNA PPO
NY143010POtherHIP
NY0760J1OtherEMPIRE BCBS
NY2799244OtherGHI
NY0760J1OtherEMPIRE BCBS
NY174025POtherHIP
NYP3463235OtherOXFORD
NYKM00760J10Medicare ID - Type UnspecifiedEMPIRE MEDICARE
NY05619Medicare ID - Type UnspecifiedGHI MEDICARE
NY02363748Medicaid