Provider Demographics
NPI:1629181987
Name:DESAI, RONAK G (DO)
Entity Type:Individual
Prefix:
First Name:RONAK
Middle Name:G
Last Name:DESAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST
Mailing Address - Street 2:SUITE SW200
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 COOPER PLZ
Practice Address - Street 2:COOPER ANESTHESIA ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1461
Practice Address - Country:US
Practice Address - Phone:856-342-2425
Practice Address - Fax:856-968-8326
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB081075207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ010077990OtherAMERICHOICE
NJ0112267Medicaid
NJ60026881OtherHORIZON NJ HEALTH
NJ7201586OtherCIGNA
NJ1353930OtherAETNA
NJ2816926OtherUNITED HEALTH CARE
NJ1355564OtherAETNA
NJ2778677000OtherAMERIHEALTH/KEYSTONE/IBC
NJ60026882OtherHORIZON NJ HEALTH
NJ60026882OtherHORIZON NJ HEALTH
NJ0112267Medicaid