Provider Demographics
NPI:1528365921
Name:DESAI, ESHA HARESH
Entity Type:Individual
Prefix:
First Name:ESHA
Middle Name:HARESH
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 KISSENA BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2950
Mailing Address - Country:US
Mailing Address - Phone:718-661-1710
Mailing Address - Fax:718-886-6414
Practice Address - Street 1:4343 KISSENA BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2950
Practice Address - Country:US
Practice Address - Phone:718-661-1710
Practice Address - Fax:718-886-6414
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist