Provider Demographics
NPI:1912741075
Name:MCKEEHAN, JAY ALEXANDER (PA-C, NREMT-P)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:ALEXANDER
Last Name:MCKEEHAN
Suffix:
Gender:M
Credentials:PA-C, NREMT-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6329A DOUGLASTON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1514
Mailing Address - Country:US
Mailing Address - Phone:435-862-8351
Mailing Address - Fax:
Practice Address - Street 1:1600 STEWART AVE STE 105
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-6611
Practice Address - Country:US
Practice Address - Phone:516-833-5505
Practice Address - Fax:516-833-5566
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY030376-01363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant