Provider Demographics
NPI:1760550271
Name:DESAI, JAYANT DOLATRAY (MD)
Entity Type:Individual
Prefix:
First Name:JAYANT
Middle Name:DOLATRAY
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16521 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4134
Mailing Address - Country:US
Mailing Address - Phone:718-657-1717
Mailing Address - Fax:718-657-7748
Practice Address - Street 1:16521 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4134
Practice Address - Country:US
Practice Address - Phone:718-657-1717
Practice Address - Fax:718-657-7748
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY144734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0832504Medicaid
NY144736OtherSTATE LICENSE
NY144736OtherSTATE LICENSE
B79394Medicare UPIN
70093AMedicare ID - Type Unspecified