Healthcare Provider Details

I. General information

NPI: 1003892902
Provider Name (Legal Business Name): NINAD DESAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 CLARKSON AVE KINGS COUNTY HOSPITAL CENTER; B 6202
BROOKLYN NY
11203-2057
US

IV. Provider business mailing address

31 HICKS LN
GREAT NECK NY
11024-2026
US

V. Phone/Fax

Practice location:
  • Phone: 718-245-4105
  • Fax: 718-245-4107
Mailing address:
  • Phone: 516-487-0929
  • Fax: 718-245-4107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number210284
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: