Provider Demographics
NPI:1619060613
Name:DENEEN, KIERAN GERARD
Entity Type:Individual
Prefix:MR
First Name:KIERAN
Middle Name:GERARD
Last Name:DENEEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W ROE BLVD
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-2333
Mailing Address - Country:US
Mailing Address - Phone:631-447-9211
Mailing Address - Fax:631-447-9214
Practice Address - Street 1:305 W ROE BLVD
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-2333
Practice Address - Country:US
Practice Address - Phone:631-447-9211
Practice Address - Fax:631-447-9214
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q16461OtherEMPIRE
Q16461OtherEMPIRE