Provider Demographics
NPI:1861021180
Name:DESIR, PARNEL E (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:DR
First Name:PARNEL
Middle Name:E
Last Name:DESIR
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2408
Mailing Address - Country:US
Mailing Address - Phone:732-545-0094
Mailing Address - Fax:
Practice Address - Street 1:18 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2408
Practice Address - Country:US
Practice Address - Phone:732-545-0094
Practice Address - Fax:732-545-4094
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-001101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1861021180OtherNPI