Provider Demographics
NPI:1770554206
Name:KEPPEL, LYNN M (PA)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:M
Last Name:KEPPEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:205 E 64 ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10021
Mailing Address - Country:US
Mailing Address - Phone:212-759-4553
Mailing Address - Fax:212-486-8334
Practice Address - Street 1:205 E 64 ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10021
Practice Address - Country:US
Practice Address - Phone:212-759-4553
Practice Address - Fax:212-486-8334
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant