Provider Demographics
NPI:1275298580
Name:GREENOUGH, KE-KHEE
Entity Type:Individual
Prefix:
First Name:KE-KHEE
Middle Name:
Last Name:GREENOUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 DUNHAM AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2528
Mailing Address - Country:US
Mailing Address - Phone:716-661-1058
Mailing Address - Fax:
Practice Address - Street 1:186 LAKE SHORE DR W
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-1437
Practice Address - Country:US
Practice Address - Phone:716-661-1590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYCPS-P-4288175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist