Provider Demographics
NPI:1801040910
Name:KEANY, ROSEMARY (SLP)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:KEANY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MS
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:KEANY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SLP
Mailing Address - Street 1:145 BEACH 73 STREET
Mailing Address - Street 2:
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11692
Mailing Address - Country:US
Mailing Address - Phone:718-318-3521
Mailing Address - Fax:718-318-3521
Practice Address - Street 1:145 BEACH 73 STREET
Practice Address - Street 2:APT. A
Practice Address - City:ARVERNE
Practice Address - State:NY
Practice Address - Zip Code:11692
Practice Address - Country:US
Practice Address - Phone:718-318-3521
Practice Address - Fax:718-318-3521
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013741235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMEDICAIDMedicaid
NYMEDICARE UPINMedicare UPIN
NYMEDICARE PINMedicare PIN