IndividualActive
Jennifer Keller
NPI 1578821385 · Physical Disabilities Residential Treatment Facility · Peconic, NY
Provider details
- NPI number
- 1578821385
- Entity type
- Individual
- Primary specialty
- Physical Disabilities Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
- License
- 494793 (NY)
Specialties & taxonomies
Residential Treatment Facilities
Practice location
1190 Arrowhead Ln
Peconic, NY 11958-1602
Phone: (631) 680-2010
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 436
Cutchogue, NY 11935-0436
Registry dates
- Enumerated
- 2012-04-30
- Last updated
- 2012-04-30
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.