Provider Demographics
NPI:1508808940
Name:DESHAW, MAX G (MD)
Entity type:Individual
Prefix:DR
First Name:MAX
Middle Name:G
Last Name:DESHAW
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 1:25 LINDSLEY DR STE 311
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-4456
Mailing Address - Country:US
Mailing Address - Phone:973-538-5844
Mailing Address - Fax:973-267-0181
Practice Address - Street 1:25 LINDSLEY DR STE 311
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-538-5844
Practice Address - Fax:973-267-0181
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64037207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJD07188900OtherCDS PHYSICIAN CERT
NJMA64037OtherNJ STATE LICENSE
NJ7326203Medicaid