Active NPI
Keith Dougherty
- Massage Therapist
- East Setauket, NY
National Provider Identifier
1659243475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Massage Therapist
- License
- 00768
- Practice address
- 17 Technology Dr
East Setauket, NY 11733-4000 - Phone
- (631) 627-1515
- NPI assigned
- Sep 22, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | 00768 | NY | Primary |
Addresses
Primary practice location
17 Technology Dr
East Setauket, NY 11733-4000
Mailing address
248 Smithtown Blvd Ste 5
Nesconset, NY 11767-2420
Phone (631) 560-2048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00768 | NY | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1758499200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758499200000",
"number": "1659243475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "248 SMITHTOWN BLVD STE 5",
"city": "NESCONSET",
"state": "NY",
"postal_code": "117672420",
"telephone_number": "631-560-2048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17 TECHNOLOGY DR",
"city": "EAST SETAUKET",
"state": "NY",
"postal_code": "117334000",
"telephone_number": "631-627-1515"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOUGHERTY",
"first_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-09-22",
"last_updated": "2025-09-22",
"certification_date": "2025-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "225700000X",
"taxonomy_group": "",
"desc": "Massage Therapist",
"state": "NY",
"license": "00768",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Setauket, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.