Provider Demographics
NPI:1104294909
Name:ROGER KESHAV MD PA
Entity type:Organization
Organization Name:ROGER KESHAV MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-7870
Mailing Address - Street 1:140 BELMONT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-1018
Mailing Address - Country:US
Mailing Address - Phone:973-751-7870
Mailing Address - Fax:973-751-7875
Practice Address - Street 1:140 BELMONT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1018
Practice Address - Country:US
Practice Address - Phone:973-751-7870
Practice Address - Fax:973-751-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09265200207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty