MEDICARE: MISS MAURA C OKEEFE PHYSICIAN ASSISTANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	012727	NY

General Provider Information

NPI Number	:	1841449824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MAURA C OKEEFE PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	25 BURNS ST
Second Line	:	APT 4 B
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	631-235-5233
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 BURNS ST
Second Line	:	APT 4 B
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-5268
Country	:	US
Telephone Number	:	631-235-5233
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2008
Last Update Date	:	09/15/2008

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