Basic Information
| Provider Information | |||||||||
| NPI: | 1851042964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KEITH | ||||||||
| FirstName: | LORETTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 249 THOMAS BOYLAND | ||||||||
| Address2: | 22K | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183469329 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2237 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112077527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186497000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2022 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | 341444250300E | NY | Y | Nursing Service Related Providers | Nurse's Aide |
No ID Information.