Healthcare Provider Details

I. General information

NPI: 1437470531
Provider Name (Legal Business Name): MARY KATHLEEN KEOWN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2010
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

534 W 135TH ST
NEW YORK NY
10031-8644
US

IV. Provider business mailing address

622 W 168TH ST # VC417
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-491-2300
  • Fax: 212-491-2323
Mailing address:
  • Phone: 212-305-6227
  • Fax: 212-305-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number271462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: