Provider Demographics
NPI:1780707398
Name:DESAI, CHAITANYA MUKESH (MD)
Entity type:Individual
Prefix:DR
First Name:CHAITANYA
Middle Name:MUKESH
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHAIT
Other - Middle Name:MUKESH
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:50 CRAGWOOD RD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-2433
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 CRAGWOOD RD
Practice Address - Street 2:SUITE 308
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-2433
Practice Address - Country:US
Practice Address - Phone:908-338-1299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08680000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine