Healthcare Provider Details

I. General information

NPI: 1578643193
Provider Name (Legal Business Name): HEMLATA KIRITKUMAR DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 72
NEW LISBON NJ
08064
US

IV. Provider business mailing address

1223 KNOX DR
YARDLEY PA
19067-4423
US

V. Phone/Fax

Practice location:
  • Phone: 609-726-1000
  • Fax:
Mailing address:
  • Phone: 215-493-0477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA05166700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: