Provider Demographics
NPI:1821186503
Name:BASAVARAJ V DESAI MDPC
Entity Type:Organization
Organization Name:BASAVARAJ V DESAI MDPC
Other - Org Name:HARBOR HEART ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BASAVARAJ
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-549-1600
Mailing Address - Street 1:205 EAST MAIN ST
Mailing Address - Street 2:SUITE 2-6
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-549-1600
Mailing Address - Fax:631-549-6839
Practice Address - Street 1:205 EAST MAIN ST
Practice Address - Street 2:SUITE 2-6
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-549-1600
Practice Address - Fax:631-549-6839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1826741207RC0000X
TXK5897207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F64655Medicare UPIN
64B641Medicare ID - Type Unspecified