Provider Demographics
NPI:1972119329
Name:DESAI, MADHAVI (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MADHAVI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WATERVIEW BOULEVARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07705
Mailing Address - Country:US
Mailing Address - Phone:862-362-1030
Mailing Address - Fax:
Practice Address - Street 1:32 WATERVIEW BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07705-0770
Practice Address - Country:US
Practice Address - Phone:862-362-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00577900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant