Provider Demographics
NPI:1437207610
Name:KESHISHIAN, PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:KESHISHIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:186 ROCHELLE AVENUE
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 AVENUE
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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB03905100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4866100Medicaid
NJKE456064Medicare ID - Type Unspecified
NJ4866100Medicaid