Healthcare Provider Details

I. General information

NPI: 1194761593
Provider Name (Legal Business Name): JAGDIP DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CLARA MAASS DR ANESTHESIA DEPARTMENT
BELLEVILLE NJ
07109-3550
US

IV. Provider business mailing address

51 RARITAN REACH RD
SOUTH AMBOY NJ
08879-3440
US

V. Phone/Fax

Practice location:
  • Phone: 908-705-6857
  • Fax:
Mailing address:
  • Phone: 732-709-3215
  • Fax: 908-994-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA07787200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA07787200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: