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General NPI Number Information
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NPI Number | 1649692690
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Entity Type | Individual
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Provider Name | EDWIN KEESHAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 679 MONTAUK HWY
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City | MONTAUK
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State | NY
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Zip | 11954-5340
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Country | US
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Telephone | 631-668-3705
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Fax | 631-668-1148
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Provider Business Mailing Address
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Address Line | 4 SPRINGVILLE RD STE B
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2290
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Country | US
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Telephone | 631-283-1123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 287227
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License Number State | NY
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