Provider Demographics
NPI:1952653248
Name:BIANCO, KERI (PA)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:
Last Name:BIANCO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KERI
Other - Middle Name:
Other - Last Name:ZACHMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:NORTHWELL HEALTH ORTHOPAEDIC INSTITUTE
Mailing Address - Street 2:611 NORTHERN BOULEVARD, SUITE 200
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5208
Mailing Address - Country:US
Mailing Address - Phone:516-723-2663
Mailing Address - Fax:516-325-7190
Practice Address - Street 1:NORTHWELL HEALTH ORTHOPAEDIC INSTITUTE
Practice Address - Street 2:611 NORTHERN BOULEVARD, SUITE 200
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5208
Practice Address - Country:US
Practice Address - Phone:516-723-2663
Practice Address - Fax:516-325-7190
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015968-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant