Basic Information
Provider Information
NPI: 1083992234
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KEEHN
FirstName: ARYEH
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: M,D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1 DIAMOND HILL RD
Address2:  
City: BERKELEY HEIGHTS
State: NJ
PostalCode: 079222104
CountryCode: US
TelephoneNumber: 9082734300
FaxNumber: 9082734300
Practice Location
Address1: 534 AVENUE E STE 2A
Address2:  
City: BAYONNE
State: NJ
PostalCode: 070023987
CountryCode: US
TelephoneNumber: 2018231303
FaxNumber: 2018230094
Other Information
ProviderEnumerationDate: 07/21/2011
LastUpdateDate: 03/09/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/09/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000XMD461422PAN Allopathic & Osteopathic PhysiciansUrology 
208800000X25MA10386000NJY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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