Provider Demographics
NPI:1841449824
Name:OKEEFE, MAURA C (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MISS
First Name:MAURA
Middle Name:C
Last Name:OKEEFE
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BURNS ST
Mailing Address - Street 2:APT 4 B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5268
Mailing Address - Country:US
Mailing Address - Phone:631-235-5233
Mailing Address - Fax:
Practice Address - Street 1:25 BURNS ST
Practice Address - Street 2:APT 4 B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5268
Practice Address - Country:US
Practice Address - Phone:631-235-5233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant