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General NPI Number Information
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NPI Number | 1457463317
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Entity Type | Organization
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Legal Business Name | ESSEX NEPHROLOGY&MEDICALCENTER,PC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 50 NEWARK AVE SUITE 301
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1185
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Country | US
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Telephone | 973-757-1787
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Fax |
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Provider Business Mailing Address
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Address Line | 14 BROWN CT
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City | LIVINGSTON
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State | NJ
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Zip | 07039-1520
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Country | US
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Telephone | 973-751-7870
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAYITHRI R KESHAV
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Credential | M.D.
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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 | 25MA06306800
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License Number State | NJ
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