Provider Demographics
NPI:1922069012
Name:DESAI, VIKAS V (MD)
Entity Type:Individual
Prefix:
First Name:VIKAS
Middle Name:V
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-2502
Mailing Address - Country:US
Mailing Address - Phone:631-581-0737
Mailing Address - Fax:631-581-0729
Practice Address - Street 1:45 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2502
Practice Address - Country:US
Practice Address - Phone:631-581-0737
Practice Address - Fax:631-581-0729
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA079458207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ096304TN1Medicare ID - Type Unspecified
NYA400009079Medicare PIN
NJF05042Medicare UPIN