Provider Demographics
NPI:1568143774
Name:DESAI, JAY (RN, CPHT-ADV, CSPT)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:RN, CPHT-ADV, CSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PLYMOUTH ST # 29
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-1673
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 PLYMOUTH ST # 29
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-1673
Practice Address - Country:US
Practice Address - Phone:732-685-3606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPT13385183700000X
MARN2360844163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No183700000XPharmacy Service ProvidersPharmacy Technician