MEDICARE: ESSEX NEPHROLOGY&MEDICALCENTER,PC

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	207RN0300X	Nephrology Physician	25MA06306800	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457463317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSEX NEPHROLOGY&MEDICALCENTER,PC

Provider Business Mailing Address
First Line	:	14 BROWN CT
Second Line	:
City	:	LIVINGSTON
State	:	NJ
Zip	:	07039-1520
Country	:	US
Telephone Number	:	973-751-7870
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 NEWARK AVE
Second Line	:	SUITE 301
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-1185
Country	:	US
Telephone Number	:	973-757-1787
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GAYITHRI R KESHAV
Credential	:	M.D.
Telephone Number	:	973-751-7870

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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