Provider Demographics
NPI:1639192156
Name:KEATING, DANIEL B (DPM)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:B
Last Name:KEATING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2693
Mailing Address - Country:US
Mailing Address - Phone:716-838-2983
Mailing Address - Fax:716-838-2942
Practice Address - Street 1:2121 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2693
Practice Address - Country:US
Practice Address - Phone:716-838-2983
Practice Address - Fax:716-838-2942
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0039411213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426000492OtherFIDELIS
NY143854EQOtherPREFERRED CARE
NY8905638OtherINDEPENDENT HEALTH
NY000510005006OtherBLUE CROSS DME
NY01009030Medicaid
NY1400131OtherGHI
NYP039413OtherWORKERS COMP
NY000510005001OtherBLUE CROSS
NY00010253001OtherUNIVERA
NY040426000492OtherFIDELIS
NY480010036Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NY000510005006OtherBLUE CROSS DME