Healthcare Provider Details

I. General information

NPI: 1790002020
Provider Name (Legal Business Name): AJIT J DESHMUKH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

IV. Provider business mailing address

22414 MERRICK BLVD
LAURELTON NY
11413-2023
US

V. Phone/Fax

Practice location:
  • Phone: 718-949-6433
  • Fax: 718-949-0331
Mailing address:
  • Phone: 718-949-6433
  • Fax: 718-949-0331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number272719
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: