Provider Demographics
NPI:1912331125
Name:DESAI, ADIT M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADIT
Middle Name:M
Last Name:DESAI
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 E MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07834-2484
Mailing Address - Country:US
Mailing Address - Phone:973-627-0187
Mailing Address - Fax:
Practice Address - Street 1:490 E MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DENVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07834-2484
Practice Address - Country:US
Practice Address - Phone:973-627-0187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03570700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist