Provider Demographics
NPI:1568401636
Name:DESAI, VIREN (MD)
Entity Type:Individual
Prefix:
First Name:VIREN
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2437
Mailing Address - Country:US
Mailing Address - Phone:201-997-0808
Mailing Address - Fax:201-997-0013
Practice Address - Street 1:221 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2437
Practice Address - Country:US
Practice Address - Phone:201-997-0808
Practice Address - Fax:201-997-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05726300207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1942398623OtherGROUP NPI NUM.
NJ5560403Medicaid
NJF20400Medicare UPIN
NJ747358Medicare ID - Type UnspecifiedINDIVIDUAL ID