Provider Demographics
NPI:1417051731
Name:KEEGAN, NADINE JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:JENNIFER
Last Name:KEEGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WOODS ROAD
Mailing Address - Street 2:
Mailing Address - City:PALISADES
Mailing Address - State:NY
Mailing Address - Zip Code:10964-0143
Mailing Address - Country:US
Mailing Address - Phone:212-288-9800
Mailing Address - Fax:212-860-7446
Practice Address - Street 1:1125 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-0143
Practice Address - Country:US
Practice Address - Phone:212-288-9800
Practice Address - Fax:212-860-7446
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172829204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP363740OtherOXFORD PROVIDER
NYN52796OtherOXFORD PROVIDER
NYN52796OtherOXFORD PROVIDER
NYP363740OtherOXFORD PROVIDER