Healthcare Provider Details

I. General information

NPI: 1326350810
Provider Name (Legal Business Name): NATASHA NIKHIL DESAI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 5TH AVE FL 3
NEW YORK NY
10036-4702
US

IV. Provider business mailing address

622 W 168TH ST PH 11
NEW YORK NY
10032-3720
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-0769
  • Fax: 212-304-7050
Mailing address:
  • Phone: 212-305-9137
  • Fax: 212-304-7050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License Number265129
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: