Provider Demographics
NPI:1326466129
Name:KEOGH, SARINA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:MARIE
Last Name:KEOGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARINA
Other - Middle Name:MARIE
Other - Last Name:MOLINARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:19 DAVIS AVE
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-776-3690
Mailing Address - Fax:732-776-3691
Practice Address - Street 1:19 DAVIS AVE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-3690
Practice Address - Fax:732-776-3691
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00331100363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical