Provider Demographics
NPI:1457463317
Name:ESSEX NEPHROLOGY&MEDICALCENTER,PC
Entity Type:Organization
Organization Name:ESSEX NEPHROLOGY&MEDICALCENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYITHRI
Authorized Official - Middle Name:R
Authorized Official - Last Name:KESHAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-751-7870
Mailing Address - Street 1:14 BROWN CT
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1520
Mailing Address - Country:US
Mailing Address - Phone:973-751-7870
Mailing Address - Fax:
Practice Address - Street 1:50 NEWARK AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-1185
Practice Address - Country:US
Practice Address - Phone:973-757-1787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06306800207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7510802Medicaid
NJ009028Medicare ID - Type Unspecified
NJG67274Medicare UPIN