Provider Demographics
NPI:1851896344
Name:DESAI, ANKURI
Entity Type:Individual
Prefix:
First Name:ANKURI
Middle Name:
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 1:1991 MARCUS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-2058
Mailing Address - Country:US
Mailing Address - Phone:516-719-3376
Mailing Address - Fax:
Practice Address - Street 1:1991 MARCUS AVE STE 300
Practice Address - Street 2:
Practice Address - City:NORTH NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-2058
Practice Address - Country:US
Practice Address - Phone:516-719-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY315924207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program