Healthcare Provider Details

I. General information

NPI: 1770817991
Provider Name (Legal Business Name): DR. SACHIN N DESAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 09/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CHURCH ST S SUITE 300A
NEW HAVEN CT
06519-1717
US

IV. Provider business mailing address

PO BOX 208064
NEW HAVEN CT
06520-8064
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4758
  • Fax: 203-785-6961
Mailing address:
  • Phone: 203-785-4730
  • Fax: 203-785-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number9999999999
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: