Provider Demographics
NPI:1366754517
Name:PASICHOW, KEITH PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:PHILIP
Last Name:PASICHOW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-1927
Mailing Address - Country:US
Mailing Address - Phone:732-266-8882
Mailing Address - Fax:888-487-1131
Practice Address - Street 1:300 2ND AVE # C110
Practice Address - Street 2:
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6210
Practice Address - Fax:888-487-1131
Is Sole Proprietor?:No
Enumeration Date:2010-07-04
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0104049207RA0401X, 207RH0002X, 2080H0002X, 208VP0000X
PAMD459333207RA0401X, 207RH0002X, 2080H0002X, 208VP0000X
NJ25MA10208200207RA0401X, 2080H0002X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0682136Medicaid
PA1035864390001Medicaid
NY04301277Medicaid