Provider Demographics
NPI:1649681891
Name:FARIDI, KEELY CATHERINE
Entity type:Individual
Prefix:
First Name:KEELY
Middle Name:CATHERINE
Last Name:FARIDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 E 34TH ST
Mailing Address - Street 2:APT 17I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4890
Mailing Address - Country:US
Mailing Address - Phone:410-599-0095
Mailing Address - Fax:
Practice Address - Street 1:225 E 34TH ST
Practice Address - Street 2:APT 17I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4890
Practice Address - Country:US
Practice Address - Phone:410-599-0095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-09
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist