Provider Demographics
NPI:1023376514
Name:KEEGAN, CAROL (DPT)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 PINE ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1718
Mailing Address - Country:US
Mailing Address - Phone:201-446-0245
Mailing Address - Fax:
Practice Address - Street 1:18-01 POLLITT DR STE 1
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2816
Practice Address - Country:US
Practice Address - Phone:201-478-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01189400208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation