Provider Demographics
NPI:1447265897
Name:KEEDY, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:KEEDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONMOUTH MEDICAL
Mailing Address - Street 2:PO BOX 8000 DEPT 601
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:732-923-7700
Mailing Address - Fax:732-923-7710
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:MONMOUTH MEDICAL CENTER
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-7700
Practice Address - Fax:732-923-7710
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME733232085R0202X
NJ25MA097104002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377634400Medicaid
NJ0473669Medicaid
FL377634400Medicaid
NJ430854CMZMedicare PIN