Provider Demographics
NPI:1356379457
Name:PRASAD, KESHAV (MD)
Entity type:Individual
Prefix:
First Name:KESHAV
Middle Name:
Last Name:PRASAD
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 1:323 SPOTSWOOD ENGLISHTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MONROE TWP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8628
Mailing Address - Country:US
Mailing Address - Phone:732-723-1000
Mailing Address - Fax:732-416-0470
Practice Address - Street 1:323 SPOTSWOOD ENGLISHTOWN RD
Practice Address - Street 2:
Practice Address - City:MONROE TWP
Practice Address - State:NJ
Practice Address - Zip Code:08831-8628
Practice Address - Country:US
Practice Address - Phone:732-723-1000
Practice Address - Fax:732-416-0470
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05960600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6407501Medicaid
NJ556913Medicare PIN
NJF93261Medicare UPIN