=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942525316
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROGER KESHAV M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2010
-----------------------------------------------------
Last Update Date | 09/14/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 BELMONT AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-751-7870
-----------------------------------------------------
Fax | 973-751-7875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 BELMONT AVE
-----------------------------------------------------
City | BELLEVILLE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07109-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-751-7870
-----------------------------------------------------
Fax | 973-751-7875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 25MA09265200
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------