Healthcare Provider Details

I. General information

NPI: 1588238406
Provider Name (Legal Business Name): DESAI VICTOR JIANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MR. DESAI JIANG

II. Dates (important events)

Enumeration Date: 05/15/2021
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date: 09/27/2022
Reactivation Date: 11/16/2022

III. Provider practice location address

317 WESTERN BLVD
JACKSONVILLE NC
28546-6338
US

IV. Provider business mailing address

425 JACK MARTIN BLVD. OCEAN UNIVERSITY MEDICAL CENTER
BRICK NJ
08724
US

V. Phone/Fax

Practice location:
  • Phone: 732-840-2200
  • Fax: 516-572-5609
Mailing address:
  • Phone: 732-840-2200
  • Fax: 516-572-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2024-02418
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: