Provider Demographics
NPI:1427347459
Name:PAUL KESHISHIAN, D.O., P.C.
Entity type:Organization
Organization Name:PAUL KESHISHIAN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KESHISHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:201-368-3384
Mailing Address - Street 1:186 ROCHELLE AVE
Mailing Address - Street 2:SUITE #2A
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4111
Mailing Address - Country:US
Mailing Address - Phone:201-368-3384
Mailing Address - Fax:201-587-0300
Practice Address - Street 1:186 ROCHELLE AVE
Practice Address - Street 2:SUITE #2A
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-4111
Practice Address - Country:US
Practice Address - Phone:201-368-3384
Practice Address - Fax:201-587-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-30
Last Update Date:2011-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB03905100261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4866100Medicaid
NJ4866100Medicaid