Provider Demographics
NPI:1508802349
Name:DESHMUKH, PRATIBHA SARJERAO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRATIBHA
Middle Name:SARJERAO
Last Name:DESHMUKH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAT
Other - Middle Name:
Other - Last Name:DESHMUKH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:142 TOTOWA RD # 8
Mailing Address - Street 2:
Mailing Address - City:TOTOWA
Mailing Address - State:NJ
Mailing Address - Zip Code:07512-2745
Mailing Address - Country:US
Mailing Address - Phone:973-904-1000
Mailing Address - Fax:973-904-1480
Practice Address - Street 1:142 TOTOWA RD # 8
Practice Address - Street 2:
Practice Address - City:TOTOWA
Practice Address - State:NJ
Practice Address - Zip Code:07512-2745
Practice Address - Country:US
Practice Address - Phone:973-904-1000
Practice Address - Fax:973-904-1480
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA034566002080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1303503Medicaid
NJC55176Medicare UPIN