Provider Demographics
NPI:1376557546
Name:JAIN, KESHANI (MD)
Entity type:Individual
Prefix:MRS
First Name:KESHANI
Middle Name:
Last Name:JAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:KESHANI
Other - Middle Name:
Other - Last Name:FERNANDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1541 RT 88 WEST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724
Mailing Address - Country:US
Mailing Address - Phone:732-836-3200
Mailing Address - Fax:732-836-3201
Practice Address - Street 1:1541 RT 88 WEST
Practice Address - Street 2:SUITE A
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724
Practice Address - Country:US
Practice Address - Phone:732-836-3200
Practice Address - Fax:732-836-3201
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07547900207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0079723Medicaid
I25993Medicare UPIN
NJ088634Medicare PIN
NJ0079723Medicaid