Provider Demographics
NPI:1891940953
Name:DESAI, POORVI (MA OTR/L)
Entity Type:Individual
Prefix:
First Name:POORVI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:MA OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 FIFTH AVENUE
Mailing Address - Street 2:APT 24G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:516-848-6839
Mailing Address - Fax:
Practice Address - Street 1:325 5TH AVE
Practice Address - Street 2:APT 24G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5038
Practice Address - Country:US
Practice Address - Phone:516-848-6839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013295-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency