Provider Demographics
NPI:1821098500
Name:KHESIN, YEVGENIY I (MD)
Entity Type:Individual
Prefix:
First Name:YEVGENIY
Middle Name:I
Last Name:KHESIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 HIGH ST
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-9601
Mailing Address - Country:US
Mailing Address - Phone:973-300-0579
Mailing Address - Fax:973-300-5535
Practice Address - Street 1:183 HIGH ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-9601
Practice Address - Country:US
Practice Address - Phone:973-300-0579
Practice Address - Fax:973-300-5535
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4236612084N0400X
NJ25MA077100002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107490Medicare PIN
NJ106323Medicare PIN
I03482Medicare UPIN