Provider Demographics
NPI:1457372161
Name:KEATING, SEAN E (DPM)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:E
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 1:3925 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-1738
Mailing Address - Country:US
Mailing Address - Phone:716-250-9999
Mailing Address - Fax:716-250-6555
Practice Address - Street 1:3925 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1738
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-6522
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0031511213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000508231008OtherBLUE CROSS DME
NY040426000224OtherFIDELIS
NY000508231001OtherBLUE CROSS
NY00010253101OtherUNIVERA
NY0005913OtherGHI
NY00674548Medicaid
NY143853EQOtherPREFERRED CARE
NYP031519OtherWORKERS COMP
NY8903862OtherINDEPENDENT HEALTH
NYA82315Medicare ID - Type Unspecified
NYT26076Medicare UPIN
NY00674548Medicaid