Healthcare Provider Details

I. General information

NPI: 1003745340
Provider Name (Legal Business Name): ANI KESHISHYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 45TH ST APT D2
UNION CITY NJ
07087-6396
US

IV. Provider business mailing address

201 45TH ST APT D2
UNION CITY NJ
07087-6396
US

V. Phone/Fax

Practice location:
  • Phone: 818-913-9787
  • Fax:
Mailing address:
  • Phone: 818-913-9787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15548300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: