Provider Demographics
NPI:1831471085
Name:CHANDRAKANT DESAI PHYSICIAN PC
Entity Type:Organization
Organization Name:CHANDRAKANT DESAI PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHANDRAKANT
Authorized Official - Middle Name:V
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-297-4064
Mailing Address - Street 1:229 ALL ANGELS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-3325
Mailing Address - Country:US
Mailing Address - Phone:845-297-4064
Mailing Address - Fax:845-297-0120
Practice Address - Street 1:229 ALL ANGELS HILL RD
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-3325
Practice Address - Country:US
Practice Address - Phone:845-297-4064
Practice Address - Fax:845-297-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY130793207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD39055Medicare UPIN