MEDICARE: JONATHAN KEIGHER PH.D.

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	103TC0700X	Clinical Psychologist	018238	NY

General Provider Information

NPI Number	:	1861729105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JONATHAN KEIGHER PH.D.

Provider Business Mailing Address
First Line	:	11 PARKSIDE CT
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2217
Country	:	US
Telephone Number	:	212-729-1080
Fax Number	:	917-633-6067

Provider Business Practice Location Address
First Line	:	11 PARKSIDE CT
Second Line	:
City	:	POMONA
State	:	NY
Zip	:	10970-2217
Country	:	US
Telephone Number	:	212-729-1080
Fax Number	:	917-633-6067

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

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	04/20/2026

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