MEDICARE: KIANDOKHT KEYHANIAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	286358	MA
2	2084N0400X	Neurology Physician	25MA12019400	NJ

General Provider Information

NPI Number	:	1508398546
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIANDOKHT KEYHANIAN M.D.

Provider Business Mailing Address
First Line	:	1044 ROUTE 23 STE 101
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6685
Country	:	US
Telephone Number	:	201-359-4618
Fax Number	:	888-355-8342

Provider Business Practice Location Address
First Line	:	1044 ROUTE 23 STE 101
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-6685
Country	:	US
Telephone Number	:	201-359-4618
Fax Number	:	888-355-8342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	02/05/2026

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