Provider Demographics
NPI:1619299062
Name:KESAVAN, SIVAGNANAM (RPH)
Entity Type:Individual
Prefix:MR
First Name:SIVAGNANAM
Middle Name:
Last Name:KESAVAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8152 267TH ST
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1530
Mailing Address - Country:US
Mailing Address - Phone:718-347-2664
Mailing Address - Fax:
Practice Address - Street 1:622 WEST 168TH ST
Practice Address - Street 2:NEW YORK-PRESBYTARIAN HOSPITAL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3748
Practice Address - Country:US
Practice Address - Phone:212-342-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049184-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist