Provider Demographics
NPI:1720226814
Name:KEANE, MARTIN J (BS IN PHARM)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:J
Last Name:KEANE
Suffix:
Gender:M
Credentials:BS IN PHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8158
Mailing Address - Country:US
Mailing Address - Phone:212-838-6450
Mailing Address - Fax:212-753-3839
Practice Address - Street 1:799 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8158
Practice Address - Country:US
Practice Address - Phone:212-838-6450
Practice Address - Fax:212-753-3839
Is Sole Proprietor?:No
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist