Provider Demographics
NPI:1780681825
Name:DESAI, HIMANSHU P (MD)
Entity Type:Individual
Prefix:
First Name:HIMANSHU
Middle Name:P
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 1:2 CAPITAL WAY STE 487
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08534-2521
Mailing Address - Country:US
Mailing Address - Phone:609-818-1900
Mailing Address - Fax:
Practice Address - Street 1:2 CAPITAL WAY STE 487
Practice Address - Street 2:
Practice Address - City:PENNINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08534-2521
Practice Address - Country:US
Practice Address - Phone:609-818-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069935L207RG0100X
NJ25MA11198600207RG0100X
OH35066332D207RG0100X
WV17863207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0959708Medicaid
PA104131640001Medicaid
PA082530PK7Medicare PIN
OH4133209Medicare PIN
WV0835848Medicare PIN
OH0959708Medicaid
WV4293821Medicare PIN
OH4133209Medicare PIN
OH4133206Medicare PIN
WV4293821Medicare PIN
OH4133203Medicare PIN