Provider Demographics
NPI:1447350970
Name:DUVERNEY, KEITH BRIAN
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:BRIAN
Last Name:DUVERNEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-6819
Mailing Address - Country:US
Mailing Address - Phone:212-675-6662
Mailing Address - Fax:212-675-6673
Practice Address - Street 1:126 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6819
Practice Address - Country:US
Practice Address - Phone:212-675-6662
Practice Address - Fax:212-675-6673
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006621111N00000X
TX7130111N00000X
NYX011776-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor