Provider Demographics
NPI:1083891345
Name:WINDING RIVER MEDICAL PARK
Entity Type:Organization
Organization Name:WINDING RIVER MEDICAL PARK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:N
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-341-8044
Mailing Address - Street 1:147 PIN OAK CT
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5323
Mailing Address - Country:US
Mailing Address - Phone:732-341-8044
Mailing Address - Fax:732-341-8055
Practice Address - Street 1:508 LAKEHURST RD
Practice Address - Street 2:BLDG 1, SUITE B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-8000
Practice Address - Country:US
Practice Address - Phone:732-341-8044
Practice Address - Fax:732-341-8055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ090371Medicare PIN