Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 721571571 | NJ |
NPI | 1407166911 |
---|---|
Provider Name | Mrs. Tracey Keegan |
First Address | Flemington, NJ 08822-6019 |
Second Address | Flemington, NJ 08822-6019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2010 |
Last Update Date | 18/10/2010 |