Healthcare Provider Details

I. General information

NPI: 1811803836
Provider Name (Legal Business Name): DEJA DESAI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 SICOMAC RD STE 305
NORTH HALEDON NJ
07508-2954
US

IV. Provider business mailing address

33 SICOMAC RD STE 305
NORTH HALEDON NJ
07508-2954
US

V. Phone/Fax

Practice location:
  • Phone: 973-348-6004
  • Fax: 973-354-6289
Mailing address:
  • Phone: 973-348-6004
  • Fax: 973-354-6289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00932800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: