Healthcare Provider Details

I. General information

NPI: 1346694114
Provider Name (Legal Business Name): DESJET LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2016
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 ACKERMAN AVENUE
CLIFTON NJ
07011
US

IV. Provider business mailing address

35 ACKERMAN AVENUE
CLIFTON NJ
07011
US

V. Phone/Fax

Practice location:
  • Phone: 973-928-2880
  • Fax: 973-928-2881
Mailing address:
  • Phone: 973-928-2880
  • Fax: 973-928-2881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AADITYA DESAI
Title or Position: MANAGER
Credential: D.O
Phone: 973-928-2880