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NPI Code Detail

MEDICARE: DR. REZA KESHAVARZ MD

MEDICARE: DR. REZA KESHAVARZ MD
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
1208000000XPediatrics Physician193157NY
22080P0204XPediatric Emergency Medicine (Pediatrics) Physician193157NY

Other Identifiers

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

General Provider Information

NPI Number : 1790877876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REZA KESHAVARZ MD
Provider Business Mailing Address
First Line : 1879 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2709
Country : US
Telephone Number : 212-423-4069
Fax Number :
Provider Business Practice Location Address
First Line : 1879 MADISON AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10035-2709
Country : US
Telephone Number : 212-423-4069
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 09/11/2025

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