Provider Demographics
NPI:1184277410
Name:KEAVENEY, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:KEAVENEY
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 1:312 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11762-1823
Mailing Address - Country:US
Mailing Address - Phone:516-804-2778
Mailing Address - Fax:
Practice Address - Street 1:312 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-1823
Practice Address - Country:US
Practice Address - Phone:516-804-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
NY2360310174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist