Provider Demographics
NPI:1144213794
Name:DESAI, DILIP N (MD PA)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:N
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 ROAD
Practice Address - Street 2:BLDG1, SUITE B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755
Practice Address - Country:US
Practice Address - Phone:732-341-8044
Practice Address - Fax:732-341-8055
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2008-03-04
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06930800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH03491Medicare UPIN
NJ031305T6CMedicare PIN