Healthcare Provider Details

I. General information

NPI: 1508891342
Provider Name (Legal Business Name): MAYA DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MAYA DESAI .M.D.

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 LEIGH CT
RANDOLPH NJ
07869-3010
US

IV. Provider business mailing address

PLAZA447,ROUTE 10 SUITE 2
RANDOLPH NJ
07869
US

V. Phone/Fax

Practice location:
  • Phone: 973-895-4514
  • Fax:
Mailing address:
  • Phone: 973-361-4555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMA35307
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: