Healthcare Provider Details

I. General information

NPI: 1508722125
Provider Name (Legal Business Name): BRENA M DESAI PEDIATRICIAN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15715 46TH AVE
FLUSHING NY
11355-2353
US

IV. Provider business mailing address

15715 46TH AVE
FLUSHING NY
11355-2353
US

V. Phone/Fax

Practice location:
  • Phone: 718-445-3029
  • Fax: 718-445-2889
Mailing address:
  • Phone: 718-445-3029
  • Fax: 718-445-2889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENA MANISH DESAI
Title or Position: OWNER
Credential: MD
Phone: 718-445-3029