Provider Demographics
NPI:1659476935
Name:UDESHI, HANSA SHIRISH (MD)
Entity Type:Individual
Prefix:
First Name:HANSA
Middle Name:SHIRISH
Last Name:UDESHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 RT 130 S
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902
Mailing Address - Country:US
Mailing Address - Phone:732-821-8550
Mailing Address - Fax:732-821-1449
Practice Address - Street 1:1445 RT 130 S
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-821-8550
Practice Address - Fax:732-821-1449
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA029578207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0384208Medicaid
C54557Medicare UPIN
UD441770Medicare ID - Type Unspecified