Provider Demographics
NPI:1285029181
Name:KESHK, KHALED
Entity Type:Individual
Prefix:
First Name:KHALED
Middle Name:
Last Name:KESHK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ACADEMY ST APT C33
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2455
Mailing Address - Country:US
Mailing Address - Phone:646-684-8280
Mailing Address - Fax:
Practice Address - Street 1:203 MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2408
Practice Address - Country:US
Practice Address - Phone:908-852-2223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03347200183500000X
NY057717183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist