Individual
JENNIFER KEEGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3 GROVE AVE, PATCHOGUE, NY 11772-4111
(631) 475-7108
(631) 475-9601
Mailing address
3 GROVE AVE, PATCHOGUE, NY 11772-4111
(631) 475-7108
(631) 475-9601
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
17200000
—
NY
Enumeration date
02/22/2016
Last updated
02/22/2016
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