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General NPI Number Information
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NPI Number | 1629333711
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Entity Type | Organization
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Legal Business Name | KESHAV M SHIVA MD PA
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Dates
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Enumeration Date | 07/05/2012
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 140 BELMONT AVE 102
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1017
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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 102
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City | BELLEVILLE
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State | NJ
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Zip | 07109-1017
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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 | DR. KSHAVAMURTHY SHIVASHANKAR
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MA4015400000
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License Number State | NJ
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