Provider Demographics
NPI:1770506446
Name:DESAI, VIJAY V (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAY
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 1:24 STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-3852
Mailing Address - Country:US
Mailing Address - Phone:203-852-2665
Mailing Address - Fax:203-899-5065
Practice Address - Street 1:24 STEVENS ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850
Practice Address - Country:US
Practice Address - Phone:203-852-2665
Practice Address - Fax:203-899-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT39563207RH0002X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H40967Medicare UPIN
CTD400000073Medicare PIN
NY111870007OtherMULTIPLAN
NY276AK2OtherEMPIRE BC/BS
NYP2494836OtherOXFORD HEALTH PLANS
CT110009464Medicare ID - Type Unspecified