Provider Demographics
NPI:1770104085
Name:KEKHMAN, DIANA (ARDMS#156912)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:KEKHMAN
Suffix:
Gender:F
Credentials:ARDMS#156912
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 E SADDLE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-1702
Mailing Address - Country:US
Mailing Address - Phone:917-750-4554
Mailing Address - Fax:
Practice Address - Street 1:411 CONTINENTAL PLZ
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-6328
Practice Address - Country:US
Practice Address - Phone:201-661-2254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1569122085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound