1285096040 NPI number — MRS. ANNE KEETZ REDMOND MS, PHD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285096040 NPI number — MRS. ANNE KEETZ REDMOND MS, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REDMOND
Provider First Name:
ANNE
Provider Middle Name:
KEETZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REDMOND
Provider Other First Name:
ANNE
Provider Other Middle Name:
FRANCES
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1285096040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 RITA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELMAR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12054-2409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-439-7140
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
673 COLUMBIA TURNPIKE
Provider Second Line Business Practice Location Address:
CAPITAL DISTRICT BEGINNINGS
Provider Business Practice Location Address City Name:
EAST GREENBUSH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-233-0544
Provider Business Practice Location Address Fax Number:
518-233-0703
Provider Enumeration Date:
03/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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