Provider Demographics
NPI:1619905403
Name:DESAI, ROSHNI J (MS,OD,FAAO)
Entity Type:Individual
Prefix:DR
First Name:ROSHNI
Middle Name:J
Last Name:DESAI
Suffix:
Gender:F
Credentials:MS,OD,FAAO
Other - Prefix:DR
Other - First Name:ROSHNI
Other - Middle Name:
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,OD,FAAO
Mailing Address - Street 1:127 NEWARK AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-2811
Mailing Address - Country:US
Mailing Address - Phone:201-333-2768
Mailing Address - Fax:201-333-3145
Practice Address - Street 1:127 NEWARK AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-2811
Practice Address - Country:US
Practice Address - Phone:201-333-2768
Practice Address - Fax:201-333-3145
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0106551Medicaid
NJ116994BETMedicare PIN