Provider Demographics
NPI:1386649861
Name:DESAI, SAGAR R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAGAR
Middle Name:R
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:98 JAMES ST
Mailing Address - Street 2:SUITE 313
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3902
Mailing Address - Country:US
Mailing Address - Phone:732-516-1550
Mailing Address - Fax:732-494-6994
Practice Address - Street 1:98 JAMES ST
Practice Address - Street 2:SUITE 313
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3902
Practice Address - Country:US
Practice Address - Phone:732-516-1550
Practice Address - Fax:732-494-6994
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2011-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07096500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8931101Medicaid
NJ063715ADCMedicare ID - Type Unspecified
NJ8931101Medicaid