Provider Demographics
NPI:1700358280
Name:DESAI, JAGRUTI
Entity Type:Individual
Prefix:DR
First Name:JAGRUTI
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-5022
Mailing Address - Country:US
Mailing Address - Phone:201-863-0631
Mailing Address - Fax:201-863-0637
Practice Address - Street 1:4300 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-5022
Practice Address - Country:US
Practice Address - Phone:201-863-0631
Practice Address - Fax:201-863-0637
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03997000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist