Provider Demographics
NPI:1598908295
Name:DESAI, NEMISH JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:NEMISH
Middle Name:JAY
Last Name:DESAI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-2602
Mailing Address - Country:US
Mailing Address - Phone:908-355-0495
Mailing Address - Fax:201-964-2638
Practice Address - Street 1:600 S BROAD ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-2602
Practice Address - Country:US
Practice Address - Phone:908-355-0495
Practice Address - Fax:201-964-2638
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI180181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice