Provider Demographics
NPI:1588767875
Name:KESHAV, GAYITHRI R (MD)
Entity type:Individual
Prefix:
First Name:GAYITHRI
Middle Name:R
Last Name:KESHAV
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELMONT AVE
Mailing Address - Street 2:STE 103
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:
Practice Address - Street 1:140 BELMONT AVE
Practice Address - Street 2:STE 103
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06306800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7510802Medicaid
NJG67274Medicare UPIN
NJ7510802Medicaid