Provider Demographics
NPI:1952391997
Name:DESAI, DEEPAK SADANAND (MD)
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:SADANAND
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 1:208 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2819
Mailing Address - Country:US
Mailing Address - Phone:631-942-5370
Mailing Address - Fax:
Practice Address - Street 1:208 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2819
Practice Address - Country:US
Practice Address - Phone:631-942-5370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA073363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ054934C07Medicare ID - Type Unspecified
NJH57281Medicare UPIN