Provider Demographics
NPI:1164623740
Name:KEENAN, REBECCA M (PAC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:KEENAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 ROUTE 206 SOUTH
Mailing Address - Street 2:
Mailing Address - City:FLANDERS
Mailing Address - State:NJ
Mailing Address - Zip Code:07836-9050
Mailing Address - Country:US
Mailing Address - Phone:973-347-3277
Mailing Address - Fax:973-347-3141
Practice Address - Street 1:183 ROUTE 206 SOUTH
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9050
Practice Address - Country:US
Practice Address - Phone:973-347-3277
Practice Address - Fax:973-347-3141
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00098400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant