Provider Demographics
NPI:1871028928
Name:DESAI, PRIYANK (DO)
Entity Type:Individual
Prefix:DR
First Name:PRIYANK
Middle Name:
Last Name:DESAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 HURON RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1508
Mailing Address - Country:US
Mailing Address - Phone:848-228-9685
Mailing Address - Fax:
Practice Address - Street 1:967 NORTH BROADWAY
Practice Address - Street 2:MEDICAL EDUCATION DEPARTMENT
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701
Practice Address - Country:US
Practice Address - Phone:914-798-8971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2022-05-11
Deactivation Date:2022-04-14
Deactivation Code:
Reactivation Date:2022-05-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program