Provider Demographics
NPI:1609818640
Name:DESAI, AJIT
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 48270
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3674
Practice Address - Country:US
Practice Address - Phone:732-324-5348
Practice Address - Fax:732-324-4811
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05873200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00217617OtherRR MDCR #
NJ2835641000OtherAMERIHEALTH #
NJ60013987OtherHORIZON NJ HEALTH #
NJ8220015OtherGHI PPO #
NJ3K3866OtherHEALTHNET #
NJI20138Medicare UPIN
NJ60013987OtherHORIZON NJ HEALTH #