Provider Demographics
NPI:1841218468
Name:DESAI, VIJAYA S (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:S
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SAINT PAULS AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-2629
Mailing Address - Country:US
Mailing Address - Phone:201-792-4286
Mailing Address - Fax:201-659-1004
Practice Address - Street 1:145 SAINT PAULS AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-2629
Practice Address - Country:US
Practice Address - Phone:201-792-4286
Practice Address - Fax:201-659-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03474300208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA03474300OtherLICENSE CERTIFICATION
NJ0451801Medicaid
NJMA03474300OtherLICENSE CERTIFICATION