Provider Demographics
NPI:1659438380
Name:KEELY, KERRY A (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:A
Last Name:KEELY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:KERRY
Other - Middle Name:A
Other - Last Name:SCHENKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:61 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-5106
Mailing Address - Country:US
Mailing Address - Phone:914-948-5157
Mailing Address - Fax:914-948-3763
Practice Address - Street 1:61 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5106
Practice Address - Country:US
Practice Address - Phone:914-948-5157
Practice Address - Fax:914-948-3763
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11-3516244OtherPRIVATE HEALTH CARE SYSTM
NY2285981OtherAETNA
NY5620587OtherAETNA
NY11-3516244OtherPOMCO
NY410045556OtherRAILROAD MEDICARE
NYP912488OtherOXFORD
NY3C1832803353OtherHEALTHNET
NY2055324OtherUNITED HEALTH CARE
NY11-3516244OtherMULTIPLAN
NY11-3516244OtherPRIVATE HEALTH CARE SYSTM
NY3C1832803353OtherHEALTHNET
NYU69359Medicare UPIN