Provider Demographics
NPI:1437235165
Name:KEHOE, JOHN E (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:KEHOE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 94TH ST
Mailing Address - Street 2:SUITE 1816
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3903
Mailing Address - Country:US
Mailing Address - Phone:718-921-3800
Mailing Address - Fax:718-921-1168
Practice Address - Street 1:9201 4TH AVE 6TH FL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7006
Practice Address - Country:US
Practice Address - Phone:718-921-3800
Practice Address - Fax:718-921-1168
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100093575001OtherUHC MEDICAID
NY149401-NYOther1199
NY230000738OtherRAILROAD MEDICARE
NY029443OtherAETNA
NY149401-NYOther1199
NYB79417Medicare UPIN