Active NPI
Marie Keogh, MPH, RD, CDN, IBCLC
- Registered Dietitian
- Kew Gardens, NY
National Provider Identifier
1912308362
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 006939-1
- Practice address
- 12335 82ND Rd
Apt 4K
Kew Gardens, NY 11415-1611 - Phone
- (516) 978-2190
- NPI assigned
- Sep 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 006939-1 | NY | Primary |
| Lactation Consultant (Non-RN) | 174N00000X | L-104888 | NY |
Addresses
Primary practice location
12335 82ND Rd
Apt 4K
Kew Gardens, NY 11415-1611
Mailing address
12335 82ND Rd
Apt 4K
Kew Gardens, NY 11415-1611
Phone (516) 978-2190
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006939-1 | NY | MD | Registered Dietitian |
| L-104888 | NY | MD | Lactation Consultant (Non-RN) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484784000000",
"number": "1912308362",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12335 82ND RD",
"address_2": "APT 4K",
"city": "KEW GARDENS",
"state": "NY",
"postal_code": "114151611",
"telephone_number": "516-978-2190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12335 82ND RD",
"address_2": "APT 4K",
"city": "KEW GARDENS",
"state": "NY",
"postal_code": "114151611",
"telephone_number": "516-978-2190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEOGH",
"first_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "MPH, RD, CDN, IBCLC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-04",
"last_updated": "2017-01-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NY",
"license": "006939-1",
"primary": true
},
{
"code": "174N00000X",
"taxonomy_group": "",
"desc": "Lactation Consultant, Non-RN",
"state": "NY",
"license": "L-104888",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kew Gardens, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.