Provider Demographics
NPI:1568590537
Name:AUBEL, KEITH MICHAEL (RD)
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:MICHAEL
Last Name:AUBEL
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GOLDENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CENTRAL ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11722-4642
Mailing Address - Country:US
Mailing Address - Phone:631-582-7355
Mailing Address - Fax:
Practice Address - Street 1:8 GOLDENWOOD CIR
Practice Address - Street 2:
Practice Address - City:CENTRAL ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11722-4642
Practice Address - Country:US
Practice Address - Phone:631-582-7355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY918096133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered