Provider Demographics
NPI:1457300642
Name:KESCHNER, ALISSA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ALISSA
Middle Name:
Last Name:KESCHNER
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 1:700 OLD BETHPAGE RD
Mailing Address - Street 2:
Mailing Address - City:OLD BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11804-1240
Mailing Address - Country:US
Mailing Address - Phone:516-293-0666
Mailing Address - Fax:516-293-8218
Practice Address - Street 1:700 OLD BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:OLD BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11804-1240
Practice Address - Country:US
Practice Address - Phone:516-293-0666
Practice Address - Fax:516-293-8218
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1993412080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine