Provider Demographics
NPI:1942378146
Name:KEYES, GERALDINE T (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:T
Last Name:KEYES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GERALDINE
Other - Middle Name:
Other - Last Name:KEYES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:501 HURLEY AVENUE
Mailing Address - Street 2:
Mailing Address - City:HURLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12443
Mailing Address - Country:US
Mailing Address - Phone:845-339-4667
Mailing Address - Fax:845-339-4668
Practice Address - Street 1:501 HURLEY AVENUE
Practice Address - Street 2:
Practice Address - City:HURLEY
Practice Address - State:NY
Practice Address - Zip Code:12443
Practice Address - Country:US
Practice Address - Phone:845-339-4667
Practice Address - Fax:845-339-4668
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY143055207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
10031637OtherCDPHP
3015OtherGHI HMO
NY00712065Medicaid
NY087004OtherMVP
10031637OtherCDPHP
NY73A391Medicare ID - Type Unspecified