Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 40QA01189400 | NJ |
NPI | 1023376514 |
---|---|
Provider Name | Dr. Carol Keegan |
First Address | Closter, NJ 07624-1718 |
Second Address | Fair Lawn, NJ 07410-2816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2012 |
Last Update Date | 02/05/2012 |