Provider Demographics
NPI:1144265943
Name:DUARTE, KEITH M (AT,C)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:M
Last Name:DUARTE
Suffix:
Gender:M
Credentials:AT,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:ESOPUS
Mailing Address - State:NY
Mailing Address - Zip Code:12429
Mailing Address - Country:US
Mailing Address - Phone:845-701-1999
Mailing Address - Fax:
Practice Address - Street 1:1 WEBSTER AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1361
Practice Address - Country:US
Practice Address - Phone:845-454-8377
Practice Address - Fax:845-454-0707
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0013852255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer