Healthcare Provider Details

I. General information

NPI: 1013413004
Provider Name (Legal Business Name): VAHAKN SHANT KESKINYAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7952 JERICHO TPKE
WOODBURY NY
11797-1204
US

IV. Provider business mailing address

1520 OLD NORTHERN BLVD
ROSLYN NY
11576-1126
US

V. Phone/Fax

Practice location:
  • Phone: 516-762-1100
  • Fax:
Mailing address:
  • Phone: 516-514-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number310026
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: