Individual
MICHAEL P KEENAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OWNER, KMFITNESS
Contact information
Practice address
93 ATLANTIC AVE, MANASQUAN, NJ 08736
(732) 292-1333
Mailing address
93 ATLANTIC AVE, MANASQUAN, NJ 08736
(732) 292-1333
Taxonomy
Speciality
Code
Description
License number
State
174H00000X
Health Educator
Primary
174H00000X
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MEDICAID
—
NJ
Enumeration date
04/24/2017
Last updated
04/24/2017
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