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General NPI Number Information
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NPI Number | 1104294909
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Entity Type | Organization
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Legal Business Name | ROGER KESHAV MD PA
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Dates
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Enumeration Date | 09/10/2015
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Last Update Date | 09/10/2015
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Provider Practice Location Address
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Address Line | 140 BELMONT AVE SUITE 102
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1018
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Country | US
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Telephone | 973-751-7870
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Fax | 973-751-7875
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Provider Business Mailing Address
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Address Line | 140 BELMONT AVE SUITE 102
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1018
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Country | US
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Telephone | 973-751-7870
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Fax | 973-751-7875
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Authorized Official
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Title or Position | OWNER
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Name | ROGER KESHAV
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Credential | MD
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Telephone | 973-751-7870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 25MA09265200
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License Number State | NJ
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