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General NPI Number Information
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NPI Number | 1841586013
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Entity Type | Individual
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Provider Name | SEVAK KESHISHYAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 350 ENGLE ST STE 6586
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-1808
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Country | US
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Telephone | 201-569-1101
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Fax |
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Provider Business Mailing Address
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Address Line | 420 DELAWARE STREET SE MMC276
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City | MINNEAPOLIS
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State | MN
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Zip | 55455
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Country | US
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Telephone | 612-624-0999
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | D95288
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | C1-0012656
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 25IA12293600
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License Number State | NJ
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