Provider Demographics
NPI:1508808940
Name:DESHAW, MAX G (MD)
Entity Type:Individual
Prefix:DR
First Name:MAX
Middle Name:G
Last Name:DESHAW
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Gender:M
Credentials:MD
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Mailing Address - Street 1:220 RIDGEDALE AVE
Mailing Address - Street 2:SUITE C2
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-1361
Mailing Address - Country:US
Mailing Address - Phone:973-538-5844
Mailing Address - Fax:973-267-0181
Practice Address - Street 1:220 RIDGEDALE AVE
Practice Address - Street 2:SUITE C2
Practice Address - City:FLORHAM PARK
Practice Address - State:NJ
Practice Address - Zip Code:07932-1361
Practice Address - Country:US
Practice Address - Phone:973-538-5844
Practice Address - Fax:973-538-3650
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2013-02-06
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Provider Licenses
StateLicense IDTaxonomies
NJMA64037207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7326203Medicaid
NJF89812Medicare UPIN
NJ7326203Medicaid