Provider Demographics
NPI:1316957707
Name:KECHEJIAN, JOANNE M (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:KECHEJIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1090
Mailing Address - Country:US
Mailing Address - Phone:631-659-1700
Mailing Address - Fax:631-659-1750
Practice Address - Street 1:59 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1090
Practice Address - Country:US
Practice Address - Phone:631-659-1700
Practice Address - Fax:631-659-1750
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197006-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY45J671OtherBLUE CROSS/ BLUE SHIELD
NYF31629Medicare UPIN
NY45J671OtherBLUE CROSS/ BLUE SHIELD