Provider Demographics
NPI:1689775942
Name:KHOSHNU, ESHA (MD)
Entity Type:Individual
Prefix:MS
First Name:ESHA
Middle Name:
Last Name:KHOSHNU
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 1:1140 BLOOMFIELD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7126
Mailing Address - Country:US
Mailing Address - Phone:973-575-1107
Mailing Address - Fax:732-563-0035
Practice Address - Street 1:1140 BLOOMFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7126
Practice Address - Country:US
Practice Address - Phone:973-575-1107
Practice Address - Fax:732-563-0035
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066241002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01661BGCMedicare ID - Type UnspecifiedMEDICARE
NJG21671Medicare UPIN