Provider Demographics
NPI:1164856027
Name:DESAI, PRITI (PT)
Entity Type:Individual
Prefix:MRS
First Name:PRITI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 SPRUCE CT
Mailing Address - Street 2:APT 98
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07014-1380
Mailing Address - Country:US
Mailing Address - Phone:973-594-0883
Mailing Address - Fax:
Practice Address - Street 1:601 BOUND BROOK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MIDDLESEX
Practice Address - State:NJ
Practice Address - Zip Code:08846-2100
Practice Address - Country:US
Practice Address - Phone:732-968-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01112300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist