Provider Demographics
NPI:1770857989
Name:DESAI, ANUBHOOTI EMMANUEL
Entity Type:Individual
Prefix:
First Name:ANUBHOOTI
Middle Name:EMMANUEL
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4803
Mailing Address - Country:US
Mailing Address - Phone:914-328-8077
Mailing Address - Fax:914-328-6083
Practice Address - Street 1:380 GROVE ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-5503
Practice Address - Country:US
Practice Address - Phone:718-628-5977
Practice Address - Fax:718-628-5978
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400069271Medicare PIN
NYG400074256Medicare PIN
NYG400076782Medicare PIN
NYA400067712Medicare PIN
NYA400073847Medicare PIN