Healthcare Provider Details

I. General information

NPI: 1104870450
Provider Name (Legal Business Name): GOPAL R DESAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CAPITAL WAY
PENNINGTON NJ
08534-2520
US

IV. Provider business mailing address

579A CRANBURY ROAD UNIVERSITY RADIOLOGY GROUP PC
EAST BRUNSWICK NJ
08816
US

V. Phone/Fax

Practice location:
  • Phone: 609-303-4244
  • Fax:
Mailing address:
  • Phone: 732-390-0040
  • Fax: 732-390-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number25MA06695600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: